US20240050117A1 - Tissue manipulation device - Google Patents
Tissue manipulation device Download PDFInfo
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- US20240050117A1 US20240050117A1 US18/209,162 US202318209162A US2024050117A1 US 20240050117 A1 US20240050117 A1 US 20240050117A1 US 202318209162 A US202318209162 A US 202318209162A US 2024050117 A1 US2024050117 A1 US 2024050117A1
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
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- A—HUMAN NECESSITIES
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- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00274—Prostate operation, e.g. prostatectomy, turp, bhp treatment
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- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
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- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00305—Constructional details of the flexible means
- A61B2017/00309—Cut-outs or slits
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00305—Constructional details of the flexible means
- A61B2017/00314—Separate linked members
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Definitions
- the claimed invention relates to surgical devices, and more specifically to a tissue manipulation device.
- a prostatectomy is a medical procedure to surgically remove the prostate gland of a male patient.
- the procedure is often performed due to disease of the prostate, such as cancer.
- the procedure may be performed by open surgery or laparoscopically by the use of endoscopic instruments through small incisions in the patient.
- the prostate is located along the urethra leading to the bladder, and removal of the prostate is performed by exposing the prostate, dissecting the tissue surrounding the prostate, removing the prostate, and then suturing the urethra to the bladder.
- One problem often encountered during a prostatectomy is that the prostate is difficult to position and maneuver by the surgeon to expose the tissue and place the tissue under tension during dissection to extract the gland. This is especially a problem with a laparoscopic prostatectomy.
- Another problem is that the neurovascular bundles adjacent to the prostate can be damaged during the prostatectomy negatively affecting normal penile functionality. Precise dissection is important to minimize damage to surrounding tissue and especially the neurovascular bundles. Therefore, it would be desirable to provide an instrument which can be inserted through the urethra to engage the prostate and then enable the prostate's position to be precisely manipulated during a prostatectomy. It would also be desirable to provide a device that may be simple to disassemble for post-procedure cleaning and sterilization.
- FIG. 1 is a perspective view of an embodiment of the tissue manipulation device
- FIG. 2 is an exploded view of a portion of the embodiment of the tissue manipulation device of FIG. 1 ;
- FIG. 3 is a cross-sectional view of the embodiment of the tissue manipulation device of FIG. 1 with a securing member in an engaged position;
- FIG. 4 A is a cross-sectional view of the embodiment of the tissue manipulation device of FIG. 1 with the securing member in an engaged position and in a first securing member position;
- FIG. 4 B is a cross-sectional view of the embodiment of the tissue manipulation device of FIG. 1 with the securing member in an engaged position and in a second securing member position;
- FIG. 5 is a cross-sectional view of the embodiment of the tissue manipulation device of FIG. 1 with the securing member in a disengaged position;
- FIG. 6 is a cross-sectional view of a distal end of a shaft portion of the embodiment of the tissue manipulation device of FIG. 1 with the end effector in a first undeployed position;
- FIG. 7 is a perspective of an embodiment of a removable assembly of the tissue manipulation device of FIG. 1 ;
- FIG. 8 is a cross-sectional view of the distal end of the shaft portion of the embodiment of the tissue manipulation device of FIG. 1 with the end effector in a second deployed position;
- FIG. 9 A is a front view of an embodiment of the securing member
- FIG. 9 B is a front view of the embodiment of the securing member of FIG. 9 A ;
- FIG. 9 C is a perspective view of the embodiment of the securing member of FIG. 9 A ;
- FIG. 10 A is a top view of the embodiment of the tissue manipulation device of FIG. 1 ;
- FIG. 10 B is a side view of the embodiment of the tissue manipulation device of FIG. 10 A ;
- FIG. 10 C is a bottom view of the embodiment of the tissue manipulation device of FIG. 10 A ;
- FIG. 11 is an exploded view of a portion of a further embodiment of the tissue manipulation device.
- FIG. 12 is a cross-sectional view of a shaft portion of the embodiment of the tissue manipulation device of FIG. 11 ;
- FIG. 13 is a cross-sectional view of the embodiment of the tissue manipulation device of FIG. 11 ;
- FIG. 14 A is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a first robotic interface
- FIG. 14 B is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a first robotic interface
- FIG. 14 C is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a first robotic interface
- FIG. 15 A is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a second robotic interface
- FIG. 15 B is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a second robotic interface
- FIG. 16 is a perspective view of an embodiment of the removable portion of an embodiment of the tissue manipulation device.
- FIG. 17 A is a side view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 16 ;
- FIG. 17 B is a partial perspective view of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 20 A ;
- FIG. 17 C is a cross-sectional view of the embodiment of the torque member taken along section line 17 C- 17 C in FIG. 17 A ;
- FIG. 17 D is top view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 16 ;
- FIG. 17 E is a cross-sectional view of the embodiment of the torque member taken along section line 17 E- 17 E in FIG. 17 A ;
- FIG. 18 A is a cross-sectional view of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken along the shaft axis;
- FIG. 18 B is a cross-sectional view of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken normal to the shaft axis adjacent to a distal end of a linear portion of the shaft portion;
- FIG. 18 C includes various cross-sectional views of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken normal to the shaft axis adjacent to a distal end of a linear portion of the shaft portion;
- FIG. 18 D is a cross-sectional view of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken along the shaft axis;
- FIG. 19 A is a partial perspective view of an embodiment of a torque member of a removable portion of an embodiment of the tissue manipulation with the shaft portion removed for clarity;
- FIG. 19 B is a further partial perspective view of the embodiment of the torque member of the removable portion of FIG. 19 A with the shaft portion removed for clarity;
- FIG. 19 C is a cross-sectional view of the embodiment of the torque member taken along section line 19 C- 19 C in FIG. 19 D ;
- FIG. 19 D is side view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 19 A ;
- FIG. 19 E is top view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 19 A ;
- FIGS. 19 F to 19 H are various partial perspective views of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 19 A ;
- FIG. 191 is a front view of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 19 A ;
- FIG. 19 J is a cross-sectional view of the embodiment of the torque member taken along section line 19 J- 17 J in FIG. 17 K ;
- FIG. 19 K is a perspective view of the embodiment of the torque member of the removable portion of FIG. 19 A ;
- FIG. 20 A is a perspective view of an embodiment of the tissue manipulation device with the shaft portion removed for clarity;
- FIG. 20 B is a perspective view of a portion of the embodiment of the tissue manipulation device of FIG. 20 A with the shaft portion removed for clarity;
- FIG. 20 C is side view of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 20 A ;
- FIGS. 20 D and 20 E are various perspective views of the torque member of the removable portion of the embodiment of the tissue manipulation device of FIG. 20 A ;
- FIG. 20 F is a cross-sectional view of the embodiment of the torque member taken along section line 20 F- 20 F in FIG. 20 C ;
- FIGS. 21 A and 21 B are a bottom perspective view and a top perspective view, respectively, of an embodiment of a tissue engaging assembly prior to assembly within an end effector assembly;
- FIGS. 22 A to 22 C are a top view, a first side view, and a second side view, respectively, of the embodiment of the tissue engaging assembly of FIGS. 21 A and 21 B ;
- FIG. 23 is a partial perspective view of a first tissue engaging arm of the embodiment of the tissue engaging assembly of FIGS. 22 A to 22 C ;
- FIG. 24 A is a bottom view of the first tissue engaging arm of FIG. 23 ;
- FIG. 24 B is a cross-sectional view of the first tissue engaging arm taken along section line 24 B- 24 B in FIG. 24 A ;
- FIG. 25 is a side view of an embodiment of an end effector assembly that includes the embodiment of the tissue engaging assembly of FIGS. 21 A and 21 B with the end effector assembly in a first undeployed position;
- FIGS. 26 A to 26 C are a side view, a top view, and a perspective view, respectively, of the embodiment of the end effector assembly of FIG. 25 in a second deployed position;
- FIG. 27 is a perspective view of the embodiment of the end effector assembly of FIG. 25 in the second deployed position with a housing of the end effector assembly removed for clarity;
- FIGS. 28 A to 28 G are various views of an embodiment of a tissue manipulation device that includes the embodiment of the end effector assembly of FIG. 25 in the first undeployed position;
- FIG. 29 A is a cross-sectional view of the embodiment of the tissue engaging assembly taken along section line 29 A- 29 A in FIG. 28 B ;
- FIG. 29 B is a cross-sectional view of the embodiment of the tissue engaging assembly taken along section line 29 B- 29 B in FIG. 28 B with the end effector assembly in the second deployed position;
- FIGS. 30 A and 30 B are a perspective view and a side view, respectively, of the tissue engaging assembly with a portion of the body portion removed for clarity and with an adjustment wheel in a locked position;
- FIGS. 31 A and 31 B are a perspective view and a side view, respectively, of the tissue engaging assembly of FIGS. 30 A and 30 B with the adjustment wheel in an unlocked position.
- a tissue manipulation device 10 includes a handle portion 12 extending along a longitudinal axis 14 from a proximal end 16 to a distal end 18 , and an adjustment member 22 is displaceably coupled to the proximal end 16 of the handle portion 12 .
- a securing member 24 is coupled to the handle portion 12 and the securing member 24 extends along a member axis 26 from a proximal end 28 to a distal end 29 .
- the securing member 24 includes an engagement portion 31 disposed at or adjacent to the distal end 29 of the securing member 24 , and the proximal end 28 of the securing member 24 is coupled to a portion of the adjustment member 22 such that the securing member 24 is displaceable along the member axis 26 between a first securing member position 133 (illustrated in FIG. 4 A ) and a second securing member position (illustrated in FIG. 4 B ).
- the securing member 24 is pivotably coupled to the handle portion 12 and is pivotably displaceable from between an engaged position 36 (illustrated in FIG. 4 A ) and a disengaged position 39 (illustrated in FIG. 5 ).
- the member axis 26 In the engaged position 36 , the member axis 26 is parallel to or coaxially aligned with the longitudinal axis 14 , and in the disengaged position 39 , the member axis 26 is not parallel to or coaxially aligned with the longitudinal axis 14 .
- the tissue manipulation device 10 also includes a shaft portion 40 extending from a proximal end 42 to a distal end 44 along a shaft axis 47 (illustrated in FIG. 10 A ), and the proximal end 42 of the shaft portion 40 is coupled to the distal end of the handle portion 12 .
- the tissue manipulation device 10 further includes an end effector 48 removably coupled to the distal end 44 of the shaft portion 40 , and the end effector is operable between a first undeployed position 49 (illustrated in FIGS. 1 and 6 ) and a second deployed position 51 (illustrated in FIG. 8 ).
- the tissue manipulation device 10 additionally includes a wire 52 (e.g., a flexible wire 52 ) extending from a proximal end 54 to a distal end 56 (illustrated in FIG. 8 ), and the distal end 56 of the wire 52 is coupled to the end effector 48 .
- the proximal end 54 of the wire 52 is removably coupled to the engagement portion 31 of the securing member 24 when the securing member 24 is in the engaged position 36 (illustrated in FIG. 4 A ) and the proximal end 54 of the wire is disengaged from the engagement portion 31 of the securing member 24 when the securing member 24 is in the disengaged position 39 (illustrated in FIG. 5 ).
- the wire 52 couples the securing member 24 and the end effector 48 such that (a) when the securing member 24 is displaced from the first securing member position 133 (illustrated in FIG. 4 A ) to the second securing member position 35 (illustrated in FIG. 4 B ), the end effector 48 is displaced from the first undeployed position 49 (illustrated in FIGS. 1 and 6 ) to the second deployed position 51 (illustrated in FIG. 8 ) and (b) when the securing member 24 is displaced from the second securing member position 35 (illustrated in FIG.
- the end effector 48 may be decoupled from the distal end 44 of the shaft portion 40 and the wire 52 is configured to be removed from the shaft portion 40 through an aperture 41 (illustrated in FIG. 3 ) defined at the distal end 44 of the shaft portion 40 .
- the wire 52 and attached end effector 48 may at least partially define a removable portion 57 (illustrated in FIG. 7 ) that may be separated and removed from the handle portion 12 and shaft portion 40 to allow the for separate processing (e.g., washing and sterilization) of the handle portion 12 and shaft portion 40 .
- the removable portion 57 may also be processed separately from, or instead of, the handle portion 12 and shaft portion 40 .
- the removable portion 57 may further include one or more components may be coupled to the wire 52 and/or the end effector 58 , such as one or more torque links 58 illustrated in FIG. 7 .
- the handle portion 12 may extend along the longitudinal axis 14 from the proximal end 16 to the distal end 18 and may include a grip portion 59 that may extend along the longitudinal axis 14 from the proximal end 16 of the handle portion 12 to a distal end 117 of the grip portion 59 at a first intermediary point 60 of the handle portion 12 that is proximal to the distal end 18 of the handle portion 12 .
- the grip portion 59 may be shaped and dimensioned to be grasped by the hand of a user during a procedure.
- the grip portion 59 may include a plurality of slots 61 that each extends parallel to the longitudinal axis 14 from a point at or distal to the proximal end 16 of the handle portion 12 to a point at or proximal to the first intermediary point 60 of the handle portion 12 .
- the plurality of slots 61 may be radially arrayed about the longitudinal axis 14 , and the plurality of slots 61 may cooperate to define a plurality of ridges 62 .
- the plurality of ridges 62 may be radially arrayed about the longitudinal axis 14 , and each of the plurality of ridges 62 may extend parallel to the longitudinal axis 14 from a point at or distal to the proximal end 16 of the handle portion 12 to a point at or proximal to the first intermediary point 60 of the handle portion 12 .
- An outer end surface 63 of each of the plurality of ridges 62 may be contoured or textured to comfortably and securely be grasped by the hand of a user during a procedure.
- the handle portion 12 may further include a central bore 64 that may extend along the longitudinal axis 14 from the proximal end 16 of the handle portion 12 to the first intermediary point 60 of the handle portion 12 or to a point distal to the first intermediary point 60 of the handle portion 12 .
- the central bore 64 may include an end portion 71 and a portion of the end portion 71 may include a threaded portion 72 .
- the tissue manipulation device 10 may further include the adjustment member 22 which is displaceably coupled to the proximal end 16 of the handle portion 12 .
- the adjustment member 22 may extend along the longitudinal axis 14 from a proximal end 65 to a distal end 66 , and an insertion portion 67 may extend from the distal end 66 to an intermediary point 68 .
- An input portion 73 may extend proximally from the insertion portion 67 , and the input portion 73 may extend from the intermediary point 68 to the proximal end 65 of the adjustment member 22 .
- the insertion portion 67 may be at least partially received in the end portion 65 of the central bore 64 of the handle portion 12 , and a threaded portion 69 of an outer surface 70 of the insertion portion 67 may threadedly engage the threaded portion 72 of the end portion 65 of the central bore 64 of the handle portion 12 . Accordingly, when a user rotates the input portion 73 (relative to the handle portion 12 ) about the longitudinal axis 14 in a first rotational direction, the adjustment member 22 displaces distally along the longitudinal axis 14 . Correspondingly, when the user rotates the input portion 73 (relative to the handle portion 12 ) about the longitudinal axis 14 in a second rotational direction, the adjustment member 22 displaces proximally along the longitudinal axis 14 .
- the tissue manipulation device 10 may include the securing member carrier 74 that may extend from a proximal end 76 to a distal end 78 along an axis that may be along or parallel to the longitudinal axis 14 .
- the securing member carrier 74 may include a pair of opposing side walls 80 a , 80 b that may have corresponding inner surfaces that are planar or substantially planar.
- a pivot post 82 may extend between, and may be fixed relative to, the pair of inner surfaces of the pair of opposing side walls 80 a , 80 b , and the pivot post 82 may extend in a direction that is transverse to the longitudinal axis 14 .
- the pivot post 82 may be disposed at any suitable location on the securing member carrier 74 , such as at or adjacent to the proximal end 76 of the securing member carrier 74 , for example.
- the securing member carrier 74 may be displaceably disposed in any suitable portion of the central bore 64 of the handle portion 12 .
- the proximal end 76 of the securing member carrier 74 may be distal to the to the proximal end 16 of the handle portion 12 and the distal end 78 of the securing member carrier 74 may be proximal to the to the distal end 18 of the handle portion 12 .
- a portion of the proximal end 76 of the securing member carrier 74 may be coupled to or in contact with a portion of the adjustment member 22 that is at or adjacent to the distal end 66 of the adjustment member 22 such that a displacement of the adjustment member 22 along the longitudinal axis 14 for a first distance in a distal direction will result in a corresponding displacement of the securing member carrier 74 along the longitudinal axis 14 for the first distance in the distal direction.
- a displacement of the adjustment member 22 along the longitudinal axis 14 for a second distance in a proximal direction will result in a corresponding displacement of the securing member carrier 74 along the longitudinal axis 14 for the second distance in the proximal direction.
- the tissue manipulation device 10 may include the securing member 24 that may extend along the member axis 26 from the proximal end 28 to the distal end 29 .
- the securing member 24 may be planar or substantially planar, and may be at least partially defined by a first side surface 84 a and a second side surface 84 b opposite to the first side surface 84 a .
- the first side surface 84 a and the second side surface 84 b may be separated by a constant width, and the width may be less than the distance separating the pair of inner surfaces of the pair of opposing side walls 80 a , 80 b of the securing member carrier 74 (illustrated in FIG. 2 ) such that all or a portion of the securing member 24 may be disposed between the pair of inner surfaces of the pair of opposing side walls 80 a , 80 b of the securing member carrier 74 when the securing member 24 is in the engaged position 36 (illustrated in FIG. 4 A ).
- the securing member 24 may include a shaft portion 86 that may extend along the member axis 26 from the proximal end 28 of the securing member 24 to an intermediate point 88 .
- a lateral portion 90 may extend distally from the shaft portion 86 , and may extend along an axis that is parallel to and offset from the member axis 26 from a point aligned with the intermediate point 88 to a point at or adjacent to the distal end 29 of the securing member 24 .
- a support arm 92 may extend from a distal portion of the lateral portion 90 that is at or adjacent to the distal end 29 of the securing member 24 .
- the support arm 92 may extend inwardly (i.e., towards the member axis 26 ) from a portion of an inner lateral edge 102 of the lateral portion 90 that is proximal to the distal end 29 of the securing member 24 .
- the support arm 92 may extend along an axis that is transverse (or substantially transverse) to the member axis 26 .
- the engagement portion 31 that is adapted to couple to the proximal end 54 of the wire 52 (as illustrated in FIG. 3 ) may be disposed on a portion of the support arm 92 , such as a portion at or adjacent to an end portion of the support arm 92 .
- the engagement portion 31 may be any feature that may removably coupled to the proximal end 54 of the wire 52 , such as a slot or a yoke feature. In other embodiments, such as embodiments not having a support arm 92 , the engagement portion 31 may be disposed at any suitable portion of the securing member 24 , such as a portion of the securing member 24 that is at or adjacent to the distal end 29 of the securing member 24 .
- the securing member 24 may also include a stop arm 94 that may extend from a portion of the lateral portion 90 that is proximal to the distal end 29 of the securing member 24 .
- the stop arm 94 may extend inwardly extend from a portion of the inner lateral edge 102 of the lateral portion 90 that is proximal to the distal end 29 of the securing member 24 .
- the stop arm 94 may extend along an axis that is transverse (or substantially transverse) to the member axis 26 , and this axis may be parallel or substantially parallel to the axis of the support arm 92 such that the stop arm 94 is proximally offset from the axis of the support arm 92 (e.g., offset in direction extending along the member axis 26 towards the proximal end 28 of the securing member 24 ).
- the stop arm 94 may be positioned on the securing member 24 such that a portion of a lower surface of the stop arm 94 may contact a portion of a stop post 96 (illustrated in FIG. 3 ) when the securing member 24 is in the first securing member position (illustrated in FIG.
- the stop post 96 may extend in a direction that is transverse to the longitudinal axis 14 (and parallel to the pivot post 82 ), and the stop post may be fixedly coupled to a portion of the handle portion 12 in any suitable location to allow for the contact between the portion of the lower surface of the stop arm 94 and the portion of the stop post 96 when the securing member 24 is in the first securing member position (illustrated in FIG. 4 A )
- the stop arm may have a curved end 95 that may be configured to contact the stop post 96 to prevent further pivoting of the securing member 24 relative to the handle member 12 .
- the securing member 24 may additionally include a resilient member 98 that may be coupled to or integrally formed with the securing member 24 .
- the resilient member 98 may be spring that extends along (or parallel to) the member axis 26 and may expand and retract along (or parallel to) the member axis 26 .
- the resilient member 98 may include a plurality of parallel portions disposed transverse to the member axis 26 , and ends of the parallel portions are coupled by alternating curved portions.
- a first end portion 99 of the resilient member 98 may be configured to be in contact with the stop post 96 when the securing member 24 is in the engaged position 36 (illustrated in FIG.
- the resilient member 98 may be coupled to any suitable portion of the securing member 24 .
- the securing member 24 may be pivotably or rotatably coupled to the securing member carrier 74 in any suitable manner.
- a pivot aperture 100 may be disposed in a portion of the securing member 24 at or adjacent to the proximal end 28 of the securing member 24 , such as a portion of the shaft portion 86 that is at or adjacent to the proximal end 28 of the securing member 24 .
- the pivot post 82 of the securing member carrier 74 may be disposed through the pivot aperture 100 such that the securing member 24 is pivotably displaceable about the pivot post 82 between the engaged position 36 (illustrated in FIG. 4 A ) and the disengaged position 39 (illustrated in FIG. 5 ).
- the securing member 24 may be pivoted (for example, about the pivot post 82 ) to any suitable degree such that the engagement portion 31 of the securing member 24 may be disengaged or decoupled from the proximal end 54 of the wire 52 .
- the member axis 26 of the securing member 24 may form an angle between 1° degree and 180° with the longitudinal axis 14 to allow the engagement portion 31 of the securing member 24 to disengage or decouple from the proximal end 54 of the wire 52 .
- the securing member 24 may translate with the securing member carrier 74 along the longitudinal axis 14 when the securing member carrier 74 is longitudinally displaced by the adjustment member 22 , as previously described.
- the first end portion 99 of the resilient member 98 of the securing member 24 is in contact with the stop post 96 coupled to the handle portion 12 , the proximal end 76 of the securing member carrier 74 is biased into engagement with the distal end 66 of the adjustment member 22 .
- the resilient member 98 also biases the engagement portion 31 of the securing member 24 (which is coupled to the proximal end 54 of the wire 52 ) toward the proximal end 16 of the handle portion 12 , which maintains tension in the wire 52 .
- the securing member 24 may also include a grip tab 104 that may facilitate the grasping of the securing member 24 by a user to pivot the securing member 24 from the engaged position 36 the disengaged position 39 , and vice versa.
- the grip tab 104 may extend from a portion of the lateral portion 90 that is proximal to the distal end 29 of the securing member 24 , and the grip tab 104 may extend outwardly from a portion of an outer lateral edge 106 of the lateral portion 90 that is proximal to the distal end 29 of the securing member 24 .
- FIG. 1 illustrates an embodiment in which the handle portion 12 includes a wheel housing portion 108 that is distal to the distal end 117 of the grip portion 59 and coupled to or integrally formed with the distal end 117 of the grip portion 59 .
- the wheel housing portion 108 may include a proximal support portion 110 and a distal support portion 112 .
- the proximal support portion 110 may be cylindrical or substantially cylindrical and may extend along the longitudinal axis 14 from a proximal end 114 to a distal end 116 .
- the proximal end 114 may be coupled to or integrally formed with the distal end 117 of the grip portion 59 , and one or more interior surfaces of the proximal support portion 110 may cooperate to form a portion of the central bore 64 of the handle portion 12 .
- the distal support portion 112 may be distal to and longitudinally offset from the proximal support portion 110 .
- the distal support portion 112 may be cylindrical or substantially cylindrical and may extend along the longitudinal axis 14 from a proximal end 118 to a distal end 120 .
- the distal end 120 of the distal support portion 112 may be disposed at or correspond to the distal end of the handle portion 12 .
- One or more interior surfaces of the distal support portion 112 may cooperate to form a portion of the central bore 64 of the handle portion 12 .
- An adjustment wheel 122 may be disposed in the space between the proximal end 118 of the distal support portion 112 and the distal end 116 of the proximal support portion 110 , and the adjustment wheel 122 will be discussed in more detail below.
- a guard portion 124 may couple the proximal support portion 110 and the distal support portion 112 .
- the guard portion 124 may include a first arm 126 having a first distal portion 127 extending from a portion of the distal support portion 112 along an axis that is substantially transverse to the longitudinal axis 14 .
- the first arm 126 may also include a first proximal portion 128 extending from a portion of the proximal support portion 110 along an axis that is substantially transverse to the longitudinal axis.
- a first lateral portion 130 may extend between an end portion of the first distal portion 127 and an end portion of the first proximal portion 128 .
- the guard portion 124 may further include a second arm 132 having a second distal portion 134 extending from a portion of the distal support portion 112 along an axis that is substantially transverse to the longitudinal axis 14 .
- the second arm 132 may also include a second proximal portion 136 extending from a portion of the proximal support portion 110 along an axis that is substantially transverse to the longitudinal axis 14 .
- a second lateral portion 138 may extend between an end portion of the second distal portion 134 and an end portion of the second proximal portion 136 .
- the second arm 132 may be symmetrical to the first arm 126 about a plane extending along the longitudinal axis 14 .
- the first arm 126 and the second arm 132 of the guard portion 124 surround the adjustment wheel 122 to protect against unwanted rotation due to inadvertent contact with the adjustment wheel 122 .
- the tissue manipulation device 10 also includes the shaft portion 40 extending from the proximal end 42 to the distal end 44 along the shaft axis 47 .
- the proximal end 42 of the shaft portion 40 may be coupled to the distal end 18 of the handle portion 12 .
- the proximal end 42 of the shaft portion 40 may be coupled to the distal end 120 of the distal support portion 112 (illustrated in FIG. 3 ).
- the proximal end 42 of the shaft portion 40 may be coupled to any suitable portion of the shaft portion 40 , such as the distal end 117 of the grip portion 59 (illustrated in FIG. 1 ) in embodiments that do not include the wheel housing portion 108 .
- the distal end 44 of the shaft portion 40 may be removably coupled to a portion of the end effector 48 .
- the shaft portion 40 may have any suitable shape or combination of shapes.
- the shaft portion 40 may include a linear portion 140 and a curved portion 142 .
- the linear portion 140 may extend from the proximal end 42 of the shaft portion to an intermediate point 144 of the shaft portion 40 .
- the portion of the shaft axis 47 that extends along the linear portion 140 may be aligned with the longitudinal axis 14 or may be parallel to the longitudinal axis 14 .
- the portion of the shaft axis 47 that extends along the linear portion 140 may form an angle (i.e., an acute angle) with the longitudinal axis 14 .
- the curved portion 142 of the shaft portion 40 may extend from the intermediate point 144 of the shaft portion 40 to the distal end 44 of the shaft portion 40 .
- the curved portion 142 may be linear and the portion of the shaft axis 47 that extends along the curved portion 142 may form an angle (i.e., an acute angle) with the longitudinal axis 14 and/or with the portion of the shaft axis 47 that extends along the linear portion 140 .
- the shaft portion 40 may not have a curved portion 142 and the linear portion 140 may extend from the proximal end 42 of the shaft portion 40 to the distal end 44 of the shaft portion 40 .
- the shaft portion 40 may not have a linear portion 140 and the curved portion 142 may extend from the proximal end 42 of the shaft portion 40 to the distal end 44 of the shaft portion 40 .
- the shaft portion 40 may have one or more exterior surfaces 145 and may have one or more interior surfaces 147 that define a shaft interior portion 146 .
- the shaft interior portion 146 may open into, be in communication, and/or be aligned with the central bore 64 of the handle portion 12 .
- the one or more exterior surfaces 145 and one or more interior surfaces 147 may have any suitable cross-sectional shape of combination of shapes.
- the one or more exterior surfaces 145 and/or the one or more interior surfaces 147 may have a circular (or polygonal) cross-sectional shape.
- the cross-sectional shape of any of the one or more exterior surfaces 145 and/or the one or more interior surfaces 147 may be uniform along the entire shaft portion 40 or along one or more segments of the shaft portion 40 (e.g., the linear portion 140 ).
- the tissue manipulation device 10 additionally includes the wire 52 that extends from the proximal end 54 to the distal end 56 (illustrated in FIG. 8 ), and the distal end 56 of the wire 52 may be coupled to a portion of the end effector 48 , such as a proximal portion 148 of the end effector 48 . All or a portion of the wire 52 may be flexible to allow the wire 52 to extend through the curved portion 142 of the shaft portion 40 .
- the wire 52 may be a single unitary part or may be an assembly of two or more segments and/or components.
- the wire 52 may include a coupling portion 52 a disposed at or adjacent to the proximal end 54 of the wire 52 .
- the proximal end 54 of the wire 52 may be removably coupled to the engagement portion 31 of the securing member 24 when the securing member 24 is in the engaged position 36 (illustrated in FIG. 4 A ), and the proximal end 54 of the wire 52 may be shaped or dimensioned to be removably engaged by the engagement portion 31 of the securing member 24 .
- the tissue manipulation device 10 additionally includes the end effector 48 removably and rotatably coupled to the distal end 44 of the shaft portion 40 , and the end effector is operable between a first undeployed position 49 (illustrated in FIGS. 1 and 6 ) and a second deployed position 51 (illustrated in FIG. 8 ).
- the distal end 56 of the wire 52 may be coupled to the proximal portion 148 of the end effector 48 such that when the securing member 24 is displaced (e.g., displaced distally in a direction along the member axis 26 ) from the first securing member position (illustrated in FIG. 4 A ) to the second securing member position 35 (illustrated in FIG.
- the end effector 48 is transitioned (e.g., expanded or deployed) from the first undeployed position 49 (illustrated in FIGS. 1 and 6 ) to the second deployed position 51 (illustrated in FIG. 8 ).
- the securing member 24 is displaced (e.g., displaced proximally in a direction along the member axis 26 ) from the second securing member position 35 (illustrated in FIG. 4 B ) to the first securing member position 133 (illustrated in FIG. 4 A )
- the end effector 48 is transitioned (or contracted) from the second deployed position 51 (illustrated in FIG. 8 ) to the first undeployed position 49 (illustrated in FIGS. 1 and 6 ).
- FIG. 10 A illustrates an embodiment of the end effector 48 having a housing 150 that extends from a proximal end 151 to a distal end 152 along an end effector axis 153 , and two windows 154 a , 154 b are formed on opposing lateral ends of the housing 150 .
- the housing 150 includes a plurality of interior surfaces that cooperate to define a cavity 156 within the housing 150 .
- In the cavity 152 disposed for extension through each of the windows 154 a , 154 b , is one of two sets 21 a and 21 b of two tissue engaging members 20 .
- the tissue engaging members 20 are extendible from the first undeployed position 49 (illustrated in FIGS. 1 and 6 ) to the second deployed position 51 (illustrated in FIG. 8 ).
- the first of the two tissue engaging members 20 is formed by a proximal member 20 a and a distal member 20 c
- the second of the two tissue engaging members 20 is formed by a proximal member 20 b and a distal member 20 d.
- Each tissue engaging member 20 represents a hinged wing which is extendible radially through their respective windows 154 a , 154 b of the distal end.
- proximal member 20 a has a socket 33 which receives a curved member or shaft extending from the distal member 20 c to form a hinge similar to a ball and socket joint.
- One side of the socket 33 extends to form a finger 34 which may be received in an opening 37 of distal member 20 c shaped to receive finger 34 .
- Proximal member 20 a has a barb 38 which extends from the other side of the socket 33 .
- proximal member 20 b has a curved member or shaft 226 which is received in socket 43 of distal member 20 d to form a hinge also similar to a ball and socket joint.
- One side of the socket 43 extends to form a finger 228 which may be received in an opening 45 of proximal member 20 b shaped to receive finger 228 .
- Proximal member 20 d has a barb 46 which extends from the other side of socket 43 .
- Proximal member 20 a and distal member 20 d may be of the same first length, and proximal member 20 b and distal member 20 c may be of the same second length, where the first length is less than the second length.
- the second set 21 b is a mirror image of the first set 21 a , and operates identically to the first set 21 a.
- a hole 230 is provided at the end 230 of distal member 20 c through which extends a pin 50 through two openings in the sides of housing 150 near the distal end 152 , and a hole is also provided at end of distal member 20 d through which the pin 50 also extends.
- a pin 53 similarly extends through holes 233 through two openings in the sides of housing 150 near the distal end 152 .
- Each of pins 50 and 53 are adjacent the one of windows 154 a , 154 b through which their respective tissue engaging member sets 21 a and 21 b are extendible and retractable.
- the end effector 48 also includes a plunger 30 disposed at least partially in the housing 150 at or adjacent to the distal end 152 of the housing 150 , and the plunger 30 is longitudinally displaceable relative to the housing 150 .
- a proximal end 158 of the plunger 30 which may correspond to (or be at or adjacent to) the proximal portion 148 of the end effector 48 , may be coupled to the distal end 56 of the wire 52 .
- the proximal end 158 of the plunger 30 may be coupled to the distal end 56 of the wire 52 in any suitable manner.
- the distal end 56 of the wire 52 may include an enlarged portion 160 (such as a ball end) that is disposed within a cavity 162 formed in a portion of the plunger 30 .
- a distal displacement of the distal end 56 of the wire 52 results in a distal displacement of the plunger 30 with respect to the housing 150
- a proximal displacement of the distal end 56 of the wire 52 results in a proximal displacement of the plunger 30 with respect to the housing 150
- the enlarged portion 160 and the cavity 162 are shaped and dimensioned configured to allow the plunger 30 (and the entire housing 150 ) to rotate relative to the distal end 56 of the wire 52 .
- the plunger 30 additionally includes two plunger sockets 30 c , 30 d formed in a distal end 164 of the plunger 30 .
- At end 49 a opposite socket 33 of proximal member 20 a forms a curved member or shaft 32 a
- at end 49 b opposite pin 42 of proximal member 20 b forms a curved member or shaft 32 b .
- tissue engaging member set 21 a curved members 32 a and 32 b of proximal members 20 a and 20 b , respectively, are received beside each other in the plunger socket 30 c and are rotatable therein.
- curved members 32 a and 32 b of proximal members 20 a and 20 b are received beside each other in the plunger socket 30 d and are rotatable therein.
- the walls 30 f forming the plunger sockets 30 c and 30 d extend upwards to form fingers with tapered ends.
- the curved members 32 a and 32 b rotate in plunger socket 30 c (for tissue engaging member set 21 a ) or 30 d (for tissue engaging member set 21 b ), rotating curved members 36 and 42 of distal and proximal members 20 c and 20 b , respectively, in sockets 33 and 43 of proximal and distal members 20 a and 20 d , respectively, as distal members 20 c and 20 d rotate about pin 51 (for tissue engaging member set 21 a ) or 54 (for tissue engaging member set 21 b ), thereby extending outwards from the distal end 16 simultaneously both sets 21 a and 21 b of tissue engaging members 20 .
- the degree of extension being controlled by the length of travel of the longitudinal drive mechanism and limited by fingers 34 and 44 of proximal and distal members 20 a and 20 d , respectively, being stopped by their full insertion into openings 37 and 45 of distal and proximal members 20 c and 20 b , respectively.
- the plunger 30 moves towards the proximal end 151 of the housing 150 , the above-described outward rotation of member 20 a - d occurs in the opposite direction, thereby retracting the tissue engaging members 20 .
- the degree of retracting may be controlled by the length of travel of the plunger 30 and limited by the surface 38 a of barb 38 of proximal member 20 a abutting the surface 23 b of distal member 20 c , and the surface 46 a of barb 46 of distal member 20 d abutting the surface 25 of proximal member 20 b .
- the tissue engaging members 20 are substantially contained in the housing 150 , and may extend slightly beyond the outer perimeter of the housing 150 , as shown in FIG. 6 .
- the securing member carrier 74 also moves distally, thereby translating the securing member 24 from the first securing member position 133 (illustrated in FIG. 4 A ) to the second securing member position 35 (illustrated in FIG. 4 B ).
- the securing member 24 displaces from the first securing member position 133 to the second securing member position 35 , the distal end 56 of the wire 52 is displaced distally, thereby moving the plunger 30 distally within the housing 150 of the end effector 48 , and the end effector 48 is displaced from the first undeployed position 49 (illustrated in FIGS. 1 and 6 ) to the second deployed position 51 (illustrated in FIG. 8 ).
- the securing member carrier 74 also moves proximally (as illustrated in FIG. 4 B , due to the bias caused by the first end portion 99 of the resilient member 98 of the securing member 24 that is in contact with the stop post 96 ), thereby translating the securing member 24 from the second securing member position 35 (illustrated in FIG. 4 B ) to the first securing member position 133 (illustrated in FIG. 4 A ).
- the distal end 56 of the wire 52 is displaced proximally, thereby moving the plunger 30 proximally within the housing 150 of the end effector 48 , and the end effector 48 is displaced from the second deployed position 51 (illustrated in FIG. 8 ) to the first undeployed position 49 .
- the end effector 48 has been described as having two sets 21 a , 21 b of two tissue engaging members 20 that are extendible from the first undeployed position 49 to the second deployed position 51 , other embodiments of the end effector are contemplated.
- the end effector 48 may be configured to extend, retract, or change position from a first position to a second position (and, optionally, further positions).
- the end effector 48 may have a fixed configuration and not transition from a first position to a second position,
- the end effector 48 may be rotatable relative to the shaft portion 40 during a procedure, providing the user with an advantageous additional rotational degree of freedom.
- the adjustment wheel 122 which may be disposed in the space between the proximal end 118 of the distal support portion 112 and the distal end 116 of the proximal support portion 110 , may be coupled to the end effector 48 to rotate the end effector 48 relative to the shaft portion 140 .
- the adjustment wheel 122 may have a central aperture 166 that may be adapted to be disposed around an outer surface 168 of a wheel hub 170 .
- the central aperture 166 may have a non-circular shape that may correspond to a non-circular shape of the outer surface 168 of the wheel hub 170 such that when the adjustment wheel 122 is rotated, the wheel hub 170 correspondingly rotates relative to the handle portion 12 (and the shaft portion 40 ).
- the wheel hub 170 may be elongated and may extend along a hub axis from a proximal end 172 to a distal end 174 , and the hub axis may be aligned with the longitudinal axis 14 . So configured, and as illustrated in FIG.
- a proximal portion 176 of the wheel hub 170 may be disposed through (and may be rotatable within) the proximal support portion 110 of the wheel housing portion 108 of the handle portion 12
- all or a portion of a distal portion 178 of the wheel hub 170 may be disposed through (and may be rotatable within) the distal support portion 112 of the wheel housing portion 108 of the handle portion 12
- the wheel hub 170 may be maintained in proper longitudinal alignment by a plurality of Belleville springs 180 that are disposed between a proximal surface of the distal support portion 112 and a surface of the adjustment wheel 122 , which is fixed to the wheel hub 170 .
- the wheel hub 170 may have a central aperture 171 that extends through the wheel hub 170 from the proximal end 172 to the distal end 174 along the hub axis, and the central aperture 171 is in communication with the central bore 64 of the handle portion 12 As such, a portion of the wire 52 may be disposed through, and may displace longitudinally within, the central aperture 171 of the wheel hub 170 .
- a plurality of gear teeth 182 may be disposed about a circumferential surface at the distal end 174 of the wheel hub 170 surrounding the central aperture 171 , and the plurality of gear teeth 182 rotate about the longitudinal axis 14 as the adjustment wheel 122 is rotated.
- the removable portion 57 of the tissue manipulation device 10 may include two or more torque links 58 that cooperate to rotatably couple the adjustment wheel 122 and the end effector 48 .
- the two or more torque links 58 may include a first torque link 58 a that may be rotatably coupled to the wheel hub 170 .
- the first torque link 58 a may be elongated and may extend along an axis from a proximal end 182 a to a distal end 184 a , and a link bore 186 a may extend through the first torque link 58 a from the proximal end 182 a to the distal end 184 a .
- a portion of the wire 52 may be disposed through, and may displace longitudinally within, the link bore 186 a .
- a plurality of gear teeth 188 a may be disposed about a circumferential surface at the distal end 184 a of the first torque link 58 a surrounding the link bore 186 a .
- a plurality of receiving notches 190 a may be disposed about a circumferential surface at the proximal end 182 a of the first torque link 58 a surrounding the link bore 186 a .
- each of the plurality of receiving notches 190 a of the first torque link 58 a may engage a corresponding one of the plurality of gear teeth 182 of the wheel hub 170 such that a rotation of the wheel hub 170 causes a corresponding rotation of the first torque link 58 a.
- Each of the two or more torque links 58 of the removable portion 57 may be identical.
- the two or more torque links 58 may also include a second torque link 58 b that may be identical to the first torque link 58 a . That is, the second torque link 58 b may be elongated and may extend along an axis from a proximal end 182 b to a distal end 184 b , and a link bore 186 b may extend through the second torque link 58 b from the proximal end 182 b to the distal end 184 b . As such, a portion of the wire 52 may be disposed through, and may displace longitudinally within, the link bore 186 b .
- a plurality of gear teeth 188 b may be disposed about a circumferential surface at the distal end 184 b of the second torque link 58 b surrounding the link bore 186 b .
- a plurality of receiving notches 190 b may be disposed about a circumferential surface at the proximal end 182 b of the second torque link 58 b surrounding the link bore 186 b .
- the second torque link 58 b may be disposed distal to the first torque link 58 a such that each of the plurality of gear teeth 188 a of the first torque link 58 a may engage a corresponding one of the plurality of receiving notches 190 b of the second torque link 58 b such that a rotation of the first torque link 58 a causes a corresponding rotation of the second torque link 58 b.
- the removable portion 57 may include any number of additional torque links 58 , which may include the most distal torque link 58 z .
- Distal torque link 58 z may be identical to the first and second torque links 58 a , 58 b , and all other included torque links 58 .
- the first torque link 58 a is rotated by a corresponding rotation of the adjustment wheel 122
- the second torque link 58 b is also rotated as previously described, and the chain reaction of rotation would also rotate the distal torque link 58 z .
- the gear teeth 188 z of the distal torque link 58 z also rotate, as would be understood by one having ordinary skill in the art.
- the connector portion 194 is fixedly coupled to the housing 150 of the end effector 48 , and when the distal torque link 58 z rotates from rotation of the adjustment wheel 122 as previously described, the end effector 40 also rotates relative to the shaft portion 40 about the end effector axis 153 .
- the two or more torque links 58 include only two torque links, so the second torque link 58 b corresponds to the distal torque link 58 z .
- the orientation of the on the gear teeth 188 a and the receiving notches 190 a previously described may be reversed.
- the proximal end 182 of the first torque link 58 a may have the gear teeth 188 a and the distal end 184 a of the first torque link 58 a may include the receiving notches 190 a , and all other torque links 58 and associated components may also be reversed.
- the gear teeth 188 a and the receiving notches 190 a may be identical features such that the orientation of the torque links 58 along the wire 52 of the removable portion 57 does not matter.
- the removable portion 57 may include the two or more torque links 58 (for example, sixteen torque links 58 ), and a portion of the wire 52 may extend through the link bore 186 of each of the two or more torque links 58 .
- the removable portion 57 may also include a spring 196 that may surround a portion of the wire 52 , and the spring may extend from a proximal end 197 to a distal end 198 along an axis aligned with the portion of the wire 52 .
- the proximal end 197 of the spring 196 may be coupled to a portion of the wire 52 adjacent to the proximal end 54 of the wire 52 , such as a distal end of the coupling portion 52 a disposed at or adjacent to the proximal end 54 of the wire 52 .
- the distal end 198 of the spring 196 may be directly or indirectly coupled to the proximal end 182 a of the first torque link 58 a .
- the distal end 198 of the spring 196 may be coupled to a proximal end of a cylindrical member 199 , and the distal end of the cylindrical member 199 may be in contact with a portion of the proximal end 182 a of the first torque link 58 a .
- the spring 195 operates to bias the first torque link 58 a towards the distal end 56 of the wire 52 , which biases the distal end 184 a of the first torque link 58 a into engagement with the proximal end 182 b of the second torque link 58 b , which similarly biases each of the remaining torque links 58 distally such that the gear teeth 188 z at the distal end 184 z of the distal torque link 58 z is biased into engagement with the corresponding receiving notches 192 on the proximal end of the connector portion 194 of the end effector 48 .
- a locking mechanism (not shown), such as a pin extending through an aperture, may couple the end effector 48 to the distal end 44 of the shaft portion 40 , and this locking mechanism should be disabled (e.g., by removing the pin) prior to removing the removable portion 57 .
- the end effector 48 may be grasped by a user and displaced along the end effector axis 153 away from the distal end 44 of the shaft portion 40 until a proximal end 200 of the removable portion 57 , which may be the proximal end 54 of the wire 52 , extends past the distal end 44 of the shaft portion 40 .
- the removable portion 57 would be bendable between any two adjacent torque links 58 , and this ability to bend allows the chain of torque links 58 allows the removable portion 57 to be passed through the curved portion 142 of the shaft portion 40 when inserting or removing the removable portion 57 for disassembly or reassembly.
- the handle portion 12 and shaft portion 40 may undergo a process (e.g., washing and sterilization).
- the removable portion 57 may also be processed separately from, or instead of, the handle portion 12 and shaft portion 40 .
- a process e.g., washing and sterilization
- the removable portion 57 may also be processed separately from, or instead of, the handle portion 12 and shaft portion 40 .
- the described steps are reversed.
- the tissue manipulation device 200 may be substantially identical to the tissue manipulation device 10 previously described, with the exception that a rigid torque member 202 may replace one or more of the torque links 58 .
- the torque member 202 may extend along an axis 205 from a proximal end 204 to a distal end 206 , and the axis 205 may be aligned with the portion of the shaft axis 47 that extends along the linear portion 140 of the shaft portion 40 .
- the torque member 202 may include a central bore 208 that extends through the torque member 202 from the proximal end 204 to the distal end 206 along the axis 205 .
- the torque member may have any suitable cross-sectional shape or combination of shapes to allow the torque member 202 to transmit torque and to fit in the linear portion 140 of the shaft portion 40 .
- the torque member 202 may be a single, unitary part or may be an assembly of two or more components that cooperate to form the torque member 202 .
- a portion of the wire 52 may be disposed through, and be longitudinally displaceable within, the central bore 208 of the torque member 202 .
- a guide sheath (not shown) may surround all or a portion of the portion of the wire 52 that extends through the central bore 208 of the torque member 202 .
- a plurality of receiving notches 210 may be disposed about a circumferential surface at the proximal end 204 of the torque member 202 surrounding the central bore 208 .
- each of the plurality of receiving notches 210 of the torque member 202 may engage a corresponding one of the plurality of gear teeth 182 of the wheel hub 170 such that a rotation of the wheel hub 170 causes a corresponding rotation of the torque member 202 about the axis 205 .
- the torque member 202 may extend distally such that the distal end 206 of the torque member 202 is disposed at or adjacent to the intermediate point 144 of the shaft portion 140 , which is at a distal end of the distal end of the linear portion 140 of the shaft portion 40 and at a proximal end of the of the curved portion 142 of the shaft portion 40 .
- a plurality of gear teeth 212 may be disposed about a circumferential surface at the distal end 204 of the torque member 202 surrounding the central bore 208 .
- the plurality of gear teeth 212 may be disposed on a removable end portion 214 that forms the distal end 206 of the torque member 202 .
- the plurality of gear teeth 212 may engage a first of two or more torque links 58 that may be identical to those previously described, and the two or more torque links 58 may be disposed in the curved portion 142 of the shaft portion 140 .
- each of the plurality of gear teeth 212 at the distal end 204 of the torque member 202 may engage a corresponding one of the plurality of receiving notches 190 a of the first torque link 58 a such that a rotation of the torque member 202 causes a corresponding rotation of the first torque link 58 a .
- the rotation of the first torque link 58 a causes a corresponding rotation of the second torque line 58 b (and any additional torque links 58 ) to rotate the end effector 48 relative to the distal end 44 of the shaft portion 40 .
- the torque member 202 efficiently transmits a torque applied to the proximal end 204 of the torque member 202 to the distal end 206 of the torque member 202 without rotational lag, allowing for precise rotational control and more immediate response when a user rotates the adjustment wheel 122 .
- the torque member 202 may not be a portion of the removable portion 57 that may be removed through the distal end 44 of the shaft portion 40 as a unit when the securing member 24 is pivoted from the engaged position 36 (illustrated in FIG. 4 A ) to the disengaged position 39 (illustrated in FIG. 5 ).
- the torque member 202 may be a portion of the removable portion 57 , and the proximal end 204 of the torque member 202 may be disposed adjacent to the proximal end 54 of the wire 52 or adjacent to a portion of the coupling portion 52 a ,
- a feature (not shown) coupled to or formed on the wire 52 (or coupling portion 52 a ) may prevent the proximal end 204 of the torque member 202 from displacing beyond the proximal end 54 of the wire 52 when the removable portion 57 is removed through the distal end 44 of the shaft portion 40 .
- FIGS. 16 to 18 D illustrate an embodiment of a removable portion 300 that may include an embodiment of a torque member 302 .
- the torque member 302 may extend along an axis 304 from a proximal end 306 to a distal end 308 , and the axis 304 may be aligned with the portion of the shaft axis 47 that extends along the linear portion 140 of the shaft portion 40 (see FIG. 10 A ).
- the axis 304 may also be parallel to or aligned with (in an unbent or linear configuration) with the X-axis of the reference coordinate system of FIGS. 16 and 17 A .
- the torque member 302 may be configured to transmit torque that is input at the proximal end 306 to the output end 308 when the torque member 302 is rotated about the axis 304 .
- the torque member 302 may also be configured to allow for bending of the torque member 302 about an axis that is normal to the axis 304 such that the torque member 302 may bend only in a first bending plane, thereby allowing the torque member 302 to efficiently transmit torque without lag or loss from slop, while allowing one or more portions of the torque member 302 to selectively bend when the removable portion 300 to be passed through the curved portion 142 of the shaft portion 40 when inserting or removing the removable portion 300 for disassembly or reassembly.
- the torque member 302 may include a base 310 that extends from the proximal end 306 to the distal end 308 .
- the base 310 may have a constant cross-sectional shape along the length of the torque member 302 .
- the cross-sectional shape of the base 310 (when viewed along the axis 304 ) may be defined by an upper edge 312 and a lower edge 314 that is parallel to and offset from the upper edge 312 .
- Each of the upper edge 312 and a lower edge 314 may be parallel to the Y-axis of the reference coordinate system of FIGS. 16 and 17 C .
- the cross-sectional shape of the base 310 may be further defined by a first lateral edge 316 and a second lateral edge 318 .
- the first lateral edge 316 may extend along or substantially along the Z-axis of the reference coordinate system of FIGS. 16 and 17 C from a first end of the upper edge 312 to a first end of the lower edge 314 .
- the second lateral edge 318 may extend along or substantially along the Z-axis of the reference coordinate system of FIGS. 16 and 17 C from a second end of the upper edge 312 to a second end of the lower edge 314 .
- Each of the first lateral edge 316 and the second lateral edge 318 may be curved to partially curved to form a segment of a circle, for example.
- a plurality of projections 320 may extend from the base 310 , and each of the plurality of projections 320 may be spaced along the X-axis of the reference coordinate system of FIGS. 16 and 17 C from an adjacent other of the plurality of projections 320 .
- the plurality of projections 320 may extend along the entire length of the base 310 from the proximal end 306 to the distal end 308 of the torque member 302 . In other embodiments, the plurality of projections 320 may extend along one or more portions of the length of the base 310 . When viewed in cross-section (along the axis 304 ), as illustrated in FIG.
- each of the plurality of projections 320 may be include a first projection portion 322 a and a second projection portion 322 b , and the first projection portion 322 a and the second projection portion 322 b may be symmetrically formed about a plane 325 , which is parallel to the X-Z plane of the reference coordinate system of FIGS. 16 and 17 C , and the plane 325 may extend along the axis 304 .
- the first projection portion 322 a may be defined by an upper projection edge 326 a and a lower projection edge 328 a .
- the lower projection edge 238 a may extend along or generally along the Y-axis of the reference coordinate system of FIGS.
- the upper projection edge 326 a may be obliquely disposed (or downwardly sloped) towards the lower projection edge 328 a as the upper projection edge 326 a extends away from the plane 325 .
- a lateral edge 330 a may extend between a first end of the upper projection edge 326 a and a first end of the lower projection edge 328 a , and the lateral edge 330 a may be at least partially curved or rounded.
- the upper projection edge 326 a , the lower projection edge 328 a , and the lateral edge 330 a may cooperate to generally form shape of a wedge.
- a second lateral edge 332 a may extend from a second end of the lower projection edge 328 a to a first portion of the upper edge 312 of the base 310 , and the second lateral edge 332 a may be least partially curved or rounded.
- the second projection portion 322 b may be a mirror image of the first projection portion 322 a and may be symmetrical to the first projection portion 322 a about the plane 325 .
- the second projection portion 322 b may be defined by an upper projection edge 326 b and a lower projection edge 328 b .
- the lower projection edge 238 b may extend along or generally along the Y-axis of the reference coordinate system of FIGS. 16 and 17 C
- the upper projection edge 326 b may be obliquely disposed (or downwardly sloped) towards the lower projection edge 328 b as the upper projection edge 326 b extends away from the plane 325 .
- a lateral edge 330 b may extend between a first end of the upper projection edge 326 b and a first end of the lower projection edge 328 b , and the lateral edge 330 b may be curved or rounded. As such, the upper projection edge 326 b , the lower projection edge 328 b , and the lateral edge 330 b may cooperate to generally form shape of a wedge.
- a second lateral edge 332 b may extend from a second end of the lower projection edge 328 b to a second portion of the upper edge 312 of the base 310 , and the second lateral edge 332 a may be least partially curved or rounded.
- Each of the plurality of projections 320 may also include a wire bore 334 from a proximal end of each of the plurality of projections 320 to a distal end of each of the plurality of projections 320 .
- Each of the wire bores 334 in each of the plurality of projections 320 may be aligned or generally aligned with the other plurality of projections 320 over the length of the axis 304 such that, in operation, a corresponding portion of the wire 52 may be disposed through, and be longitudinally displaceable within, the wire bore 334 of each of the plurality of projections 320 .
- the wire bore 334 may have any suitable shape to receive the corresponding portion of the wire 52 .
- the wire bore 334 may be a substantially U-shaped notch 336 formed between the first projection portion 322 a and the second projection portion 322 b , and the notch may extend through and along the plane 325 .
- the notch may have a first lateral portion 338 a that extends downwardly from a second end of the upper projection edge 326 a of the first projection portion 322 a and a second lateral portion 338 b that extends downwardly from a second end of the upper projection edge 326 b of the second projection portion 322 b .
- a notch end edge 340 may extend (e.g., extend parallel to or generally parallel to the Y-axis of the reference coordinate system of FIGS. 16 and 17 C ) between an end of the first lateral portion 338 a and an end of the second lateral portion 338 b.
- each of the plurality of projections 320 may be spaced along the X-axis of the reference coordinate system of FIGS. 16 and 17 C from an adjacent other of the plurality of projections 320 .
- a first 320 a of the plurality or projections 320 may have a distal lateral edge 342 a that may be disposed a first distance D 1 along the X-axis from a proximal lateral edge 344 b of a second 320 b of the plurality or projections 320 .
- the second 320 a of the plurality or projections 320 may have a distal lateral edge 342 b that may be disposed a second distance D 2 along the X-axis from a proximal lateral edge 344 c of a third 320 c of the plurality or projections 320 .
- the first distance D 1 may be equal to the second distance D 2 .
- the distance along the X-axis between a distal lateral edge 342 x of any of the plurality of projections 320 from a proximal lateral edge 344 x of an adjacent one of the plurality or projections 320 may be the first distance D 1 .
- a first neck edge 346 and a second neck edge 348 extends obliquely towards the base 310 to form a narrowed neck portion 350 that upwardly extends from the base 310 .
- the spacing between the first and second adjacent plurality of projections 320 , as well as the combination of cross-sectional shapes of each of the plurality of projections 320 allow the torque member 302 to bend along an axis that is parallel to the Y-axis of the reference coordinate system of FIGS. 16 and 17 A , that this axis may be normal to the plane 325 .
- any portion of the torque member 302 may bend clockwise or counterclockwise about the axis when viewed along the Y-axis, as shown in FIG. 17 A .
- rotation is allowed in a single bending plane (plane 325 ), but not along any other planes or along any axis that is not parallel to the Y-axis of the reference coordinate system of FIGS. 16 and 17 A .
- This ensure sufficient rigidity of the torque member 302 when the torque member 302 is rotated about the X-axis of the reference coordinate system of FIGS. 16 and 17 A while allowing the torque member 302 to bend within a single plane to allow for insertion or extraction of the removable portion 300 through the curved portion 142 of the shaft portion 40 .
- the torque member 302 may also include one or more alignment features 352 that ensures that the removable portion 300 is oriented correctly when inserted into the distal end 44 of the shaft portion 40 during the assembly (or reassembly) of the tissue manipulating device 10 .
- the one or more alignment features 352 may include a protrusion 356 formed at or adjacent to the distal end 354 of the linear portion 140 of the shaft portion 40 or at or adjacent to the proximal end of the curved portion 142 of the shaft portion 40 .
- the protrusion 356 may be formed as a depression (e.g., a dome-shaped depression) in the shaft portion 40 and the depression may extend into the shaft interior portion 146 .
- the depression may be a dome-shaped depression that may be symmetrically formed or disposed about a plane that extends through the shaft axis 47 and is parallel to the X-Z of the reference coordinate system of FIGS. 1 and 18 D , and the depression may be formed on an upper surface of the shaft portion 40 , wherein the direction “upper” corresponds to the direction along the Z-axis in which the curved portion 142 of the shaft portion 40 extends.
- the alignment feature 352 such as the depression, may be positioned to not contact a portion of the upper projection edges 326 a , 326 b of the first projection portion 322 a or the second projection portion 322 b of the torque member 302 when the removable portion 300 is positioned correctly for insertion. However, when the removable portion 300 is positioned incorrectly upon insertion into the shaft portion 40 , the alignment feature 352 may contact a portion of the sloped upper projection edges 326 a , 326 b of the first projection portion 322 a or the second projection portion 322 b to rotate the torque member 302 , and the entire removable portion 300 , into correct alignment to allow for the curving of the torque member 302 upon insertion into the shaft portion 40 .
- FIG. 18 C illustrates various orientations of the torque member 302 relative to the alignment feature 352 within the shaft portion 40 .
- FIGS. 19 A to 19 K illustrate a further embodiment of a removable portion 400 that may include an embodiment of a torque member 402 that may be similar to, but have a slightly different cross-sectional shape from, the torque member 302 illustrated in FIGS. 16 to 18 D .
- the torque member 402 may extend along an axis 404 from a proximal end 406 to a distal end 408
- the torque member 402 may include a base 410 that extends from the proximal end 406 to the distal end 408 .
- the base 410 may have a constant cross-sectional shape along the length of the torque member 402 .
- FIG. 19 K illustrate a further embodiment of a removable portion 400 that may include an embodiment of a torque member 402 that may be similar to, but have a slightly different cross-sectional shape from, the torque member 302 illustrated in FIGS. 16 to 18 D .
- the torque member 402 may extend along an axis 404 from a proximal end 406 to
- the cross-sectional shape of the base 410 (when viewed along the axis 404 ) may be defined by an upper edge 412 and a lower edge 314 that is parallel to and offset from the upper edge 412 . Each of the upper edge 412 and a lower edge 414 may be parallel to the Y-axis of the reference coordinate system of FIG. 19 J .
- the cross-sectional shape of the base 410 may be further defined by a first lateral edge 416 and a second lateral edge 418 .
- the first lateral edge 416 may extend along or substantially along the Z-axis of the reference coordinate system of FIG. 19 J from a first end of the upper edge 412 to a first end of the lower edge 414 .
- the second lateral edge 418 may extend along or substantially along the Z-axis of the reference coordinate system of FIG. 19 J from a second end of the upper edge 412 to a second end of the lower edge 414 .
- Each of the first lateral edge 416 and the second lateral edge 418 may be curved, contoured, or partially curved.
- a plurality of projections 420 may extend from the base 410 , and each of the plurality of projections 420 may be spaced along the X-axis of the reference coordinate system of FIG. 19 D from an adjacent other of the plurality of projections 420 .
- the plurality of projections 420 may extend along the entire length of the base 410 or may extend along one or more portions of the length of the base 410 . When viewed in cross-section (along the axis 404 ), as illustrated in FIG.
- each of the plurality of projections 420 may be include a first projection portion 422 a and a second projection portion 422 b , and the first projection portion 422 a and the second projection portion 422 b may be symmetrically formed about a plane 425 , which is parallel to the X-Z plane of the reference coordinate system of FIGS. 19 C and 19 D , and the plane 425 may extend along the axis 404 .
- the first projection portion 422 a may be defined by an upper projection edge 426 a which may extend along or generally along the Y-axis of the reference coordinate system of FIG.
- a lateral edge 430 a may extend between a first end of the upper projection edge 326 a and a first end of the base 410 (e.g., a first end of the upper edge 412 of the base 410 ), and the lateral edge 430 a may be at least partially curved or rounded.
- the second projection portion 422 b may be a mirror image of the first projection portion 422 a and may be symmetrical to the first projection portion 422 a about the plane 425 .
- the second projection portion 422 b may be defined by an upper projection edge 426 b which may extend along or generally along the Y-axis of the reference coordinate system of FIG.
- a lateral edge 430 b may extend between a first end of the upper projection edge 426 b and a second end of the base 410 (e.g., a second end of the upper edge 412 of the base 410 ), and the lateral edge 430 b may be at least partially curved or rounded.
- Each of the plurality of projections 420 may also include a wire bore 434 that from a proximal end of each of the plurality of projections 420 to a distal end of each of the plurality of projections 420 .
- Each of the wire bores 434 in each of the plurality of projections 420 may be aligned or generally aligned with the other plurality of projections 420 over the length of the axis 404 such that, in operation, a corresponding portion of the wire 52 may be disposed through, and be longitudinally displaceable within, the wire bore 434 of each of the plurality of projections 420 .
- the wire bore 434 may have any suitable shape to receive the corresponding portion of the wire 52 .
- the wire bore 434 may be a substantially U-shaped notch 436 formed between the first projection portion 422 a and the second projection portion 422 b , and the notch 436 may extend through and along the plane 425 .
- the notch 436 may have a first lateral portion 438 a that extends downwardly from a second end of the upper projection edge 426 a of the first projection portion 422 a and a second lateral portion 438 b that extends downwardly from a second end of the upper projection edge 426 b of the second projection portion 422 b .
- a notch bottom edge 440 may extend between an end of the first lateral portion 438 a and an end of the second lateral portion 438 b , and the notch bottom edge 440 may have the shape of a segment of a circle.
- each of the plurality of projections 420 may be spaced along the X-axis of the reference coordinate system of FIGS. 19 D and 19 K from an adjacent other of the plurality of projections 420 .
- a first 420 a of the plurality or projections 420 may have a distal lateral edge 442 a that may be disposed a first distance D 1 along the X-axis from a proximal lateral edge 444 b of a second 420 b of the plurality or projections 420 .
- the second 420 a of the plurality or projections 420 may have a distal lateral edge 442 b that may be disposed a second distance D 2 along the X-axis from a proximal lateral edge 444 c of a third 420 c of the plurality or projections 420 .
- the first distance D 1 may be equal to the second distance D 2 .
- the distance along the X-axis between a distal lateral edge 442 x of any of the plurality of projections 420 from a proximal lateral edge 444 x of an adjacent one of the plurality or projections 420 may be the first distance D 1 .
- a first neck edge 446 and a second neck edge 448 extends obliquely towards the base 410 to form a narrowed neck portion 450 that extends upward from the base 410 .
- the spacing between the first and second adjacent plurality of projections 420 , as well as the combination of cross-sectional shapes of each of the plurality of projections 420 allow the torque member 402 to bend along an axis that is parallel to the Y-axis of the reference coordinate system of FIGS. 19 C and 19 D , that this axis may be normal to the plane 425 .
- any portion of the torque member 402 may bend clockwise or counterclockwise about the axis when viewed along the Y-axis, as shown in FIG. 19 D .
- rotation is allowed in a single bending plane (plane 425 ), but not along any other planes or along any axis that is not parallel to the Y-axis of the reference coordinate system of FIG. 19 D .
- This ensures sufficient rigidity of the torque member 402 when the torque member 402 is rotated about the X-axis of the reference coordinate system of FIGS. 19 D and 19 K while allowing the torque member 402 to bend within a single plane to allow for insertion or extraction of the removable portion 400 through the curved portion 142 of the shaft portion 40 .
- FIGS. 20 A to 20 F illustrate a further embodiment of a removable portion 500 that may include an embodiment of a torque member 502 that may be similar to, but have a different cross-sectional shape from, the torque member 302 illustrated in FIGS. 16 to 18 D and the torque member 402 illustrated in FIGS. 19 A to 19 K .
- the torque member 502 may extends along an axis 504 from a proximal end 506 to a distal end 508
- the torque member 502 may include a base 510 that extends from the proximal end 506 to the distal end 508 , and the base 510 may be similar to the base 410 of base 310 previously described.
- a plurality of projections 520 may extend from the base 510 , and each of the plurality of projections 520 may be spaced along the X-axis of the reference coordinate system of FIG. 20 A from an adjacent other of the plurality of projections 420 , in a manner similar or identical to the plurality of projections 420 or the plurality of projections 320 previously described.
- Each of the plurality of projections may have a rectangular of square (or substantially rectangular or square) cross-sectional shape, as illustrated in FIG. 20 F .
- Each of the plurality of projections 520 may also include a wire bore 534 that extends from a proximal end of each of the plurality of projections 520 to a distal end of each of the plurality of projections 520 .
- Each of the wire bores 534 in each of the plurality of projections 520 may be aligned or generally aligned with the other plurality of projections 520 over the length of the axis 504 such that, in operation, a corresponding portion of the wire 52 may be disposed through, and be longitudinally displaceable within, the wire bore 534 of each of the plurality of projections 520 .
- the wire bore 534 may have any suitable shape to receive the corresponding portion of the wire 52 .
- the wire bore 534 may be cylindrical and may have an axis that extends parallel to the X-axis of the reference coordinate system of FIG. 20 C .
- the wire bore 534 may have a circular edge 540 that may be symmetrically disposed about a plane 525 that is parallel to the X-Z plane of the reference coordinate system of FIG. 20 A , and the plane 525 may extend along the axis 504 .
- each of the plurality of projections 520 may be spaced along the X-axis of the reference coordinate system of FIG. 20 C from an adjacent other of the plurality of projections 520 in a manner identical to that of the plurality of projections 420 or the plurality of projections 320 previously described.
- the spacing between the first and second adjacent plurality of projections 520 , as well as the combination of cross-sectional shapes of each of the plurality of projections 520 allow the torque member 502 to bend along an axis that is parallel to the Y-axis of the reference coordinate system of FIG. 20 A , that this axis may be normal to the plane 525 .
- any portion of the torque member 502 may bend clockwise or counterclockwise about the axis when viewed along the Y-axis, as shown in FIG. 20 C .
- rotation is allowed in a single bending plane (plane 525 ), but not along any other planes or along any axis that is not parallel to the Y-axis of the reference coordinate system of FIG. 20 A .
- this ensures sufficient rigidity of the torque member 502 when the torque member 502 is rotated about the X-axis of the reference coordinate system of FIG. 20 A while allowing the torque member 502 to bend within a single plane to allow for insertion or extraction of the removable portion 500 through the curved portion 142 of the shaft portion 40 .
- the torque member 202 may be comprised of any suitable material or combination of materials, such as plastic or stainless steel.
- a tissue engaging assembly 600 may be used instead of the tissue engaging members 20 of the end effector 48 illustrated in FIGS. 8 , 11 , and 12 .
- the tissue engaging assembly 600 may be used in an embodiment of an end effector assembly 602 illustrated in FIGS. 25 to 26 C , and the embodiment of the end effector assembly 602 will be described in more detail below.
- the embodiment of the end effector assembly 602 may be used in the embodiment of the tissue manipulation device 10 previously described or in any other embodiment of a tissue manipulation device, and the end effector assembly 602 may rotate or otherwise displace relative to the distal end 44 of the shaft portion 40 as previously described.
- the tissue engaging assembly 600 may be a single, unitary part that may allow for two or more tissue engaging arms 604 that may be deployable to secure and/or displace a patient's prostate during a procedure.
- This single part may be manufactured or produced in any suitable manner, such as by injection molding the part using a plastic material. Similar to the end effector 48 , the end effector assembly 602 may be displaced from a first undeployed position 603 (illustrated in FIG. 25 ) to a second deployed position 605 (illustrated in FIGS. 26 A to 26 C ).
- the end effector assembly 602 may be in the first undeployed position 603 to be inserted into the urethra of a patient, then the end effector assembly 602 may be transitioned to the second deployed position 605 when positioned within a portion of the patent's prostate, allowing the surgeon to physically manipulate or position the prostate as desired.
- the end effector assembly 602 may be transitioned back to the first undeployed position 603 and removed from the urethra.
- the tissue engaging assembly 600 may include two, three, four, or more tissue engaging arms 604 .
- the tissue engaging assembly 600 may include four tissue engaging arms 604 , which includes a first tissue engaging arm 604 a , a second tissue engaging arm 604 b , a third tissue engaging arm 604 c , and a fourth tissue engaging arm 604 d .
- FIGS. 21 A to 22 C illustrates the pre-assembled configuration of the tissue engaging assembly 600 , such as the configuration of the tissue engaging assembly 600 after injection molding and before assembly or integration into the end effector assembly 602 as illustrated in FIGS. 25 to 27 .
- FIG. 21 A to 22 C illustrates the pre-assembled configuration of the tissue engaging assembly 600 , such as the configuration of the tissue engaging assembly 600 after injection molding and before assembly or integration into the end effector assembly 602 as illustrated in FIGS. 25 to 27 .
- the first tissue engaging arm 604 a may be elongated and may extend from a first end 606 a to a second end 608 a along a first arm axis 610 a that may be parallel to (or aligned with) the X-axis of the reference coordinate system of FIG. 22 A , and the first end 606 a may be coupled to a first portion 611 a of a hub portion 611 .
- the first tissue engaging arm 604 a may include two or more arm segments, and in some embodiments, the first tissue engaging arm 604 a may include a first arm segment 612 a , a second arm segment 614 a , and a third arm segment 616 a.
- the first arm segment 612 a of the first tissue engaging arm 604 a may extend from a first end 618 a to a second end 620 a along the first arm axis 610 a .
- the first end 618 a of the first arm segment 612 a may be adjacent to (or may correspond to) the first end 606 a of the first tissue engaging arm 604 a , and the first end 618 a may be coupled to (and be adjacent to and offset from) the first portion 611 a of the hub portion 611 .
- the first end 618 a of the first arm segment 612 a may be coupled to the first portion 611 a of the hub portion 611 in any suitable manner, such as with a first hinge 622 a .
- the first hinge 622 a may be a living hinge that may extend between the first end 618 a of the first arm segment 612 a and the first portion 611 a of the hub portion 611 .
- the first arm segment 612 a may have any cross-sectional shape or combination of shapes (when viewed along the first arm axis 610 a ) from the first end 618 a to the second end 620 a .
- the first arm segment 612 a may have a constant or substantially constant cross-sectional shape (when viewed along the first arm axis 610 a ) from the first end 618 a to the second end 620 a
- the cross-sectional shape of first arm segment 612 a may have a polygonal shape.
- the cross-sectional shape of the first arm segment 612 a may be partially defined by a pair of opposed lateral edges 615 a , 617 a that may be parallel (or generally parallel) and extend along (or generally along) the Z-axis of the reference coordinate system of FIGS. 22 A and 24 B .
- the cross-sectional shape of the first arm segment 612 a may also be partially defined by a pair of inner lateral edges 619 a , 621 a that each extends from an end of corresponding one of the pair of opposed lateral edges 615 a , 617 a , and the pair of inner lateral edges 619 a , 621 a converge along the Z-axis to form a V-shape.
- the second arm segment 614 a of the first tissue engaging arm 604 a may extend from a first end 625 a to a second end 626 a along the first arm axis 610 a , and the first end 625 a may be adjacent to (and offset from) the second end 620 a of the first arm segment 612 a .
- the first end 625 a of the second arm segment 614 a may be coupled to the second end 620 a of the first arm segment 612 a in any suitable manner, such as with a second hinge 627 a .
- the second hinge 627 a may be a living hinge that may extend between the first end 625 a of the second arm segment 614 a and the second end 620 a of the first arm segment 612 a .
- the cross-sectional shape of the second arm segment 614 a may be identical or substantially identical to the cross-sectional shape of the first arm segment 612 a.
- the third arm segment 616 a may extend from a first end 628 a to a second end 629 a along the first arm axis 610 a , and the first end 628 a may be adjacent to (and offset from) the second end 626 a of the second arm segment 614 a .
- the first end 628 a of the third arm segment 616 a may be coupled to a second end 626 a of the second arm segment 614 a in any suitable manner, such as with a third hinge 630 a .
- the third hinge 630 a may be a living hinge that may extend between the first end 628 a of the third arm segment 616 a and the second end 626 a of the second arm segment 614 a .
- the second end 629 a of the third arm segment 616 a may be coupled to a portion of the first end cap segment 632 a in any suitable manner, such as with a fourth hinge 633 a .
- the fourth hinge 633 a may be a living hinge that may extend between the second end 629 a of the third arm segment 616 a and the portion of the first end cap segment 632 a .
- the cross-sectional shape of the second arm segment 614 a may be identical or substantially identical to the cross-sectional shape of the first arm segment 612 a and/or the second arm segment 614 a.
- a first mating feature 632 a of the first arm segment 612 a may engage a corresponding first mating feature 634 a of the second arm segment 614 a (or a corresponding one or more portions of the first mating feature 634 a of the second arm segment 614 a ) to maintain the first arm segment 612 a and the second arm segment 614 a in a desired position when the end effector assembly 602 is in the second deployed position 605 .
- the first mating feature 632 a of the first arm segment 612 a may include a first notch 636 a that may be configured to receive a first protrusion 638 a of the first mating feature 634 a of the second arm segment 614 a .
- a forward contact surface 640 a may define a portion of the first protrusion 638 a
- the forward contact surface 640 a may be configured to contact an oblique contact surface 642 a that defines a portion of the first notch 636 a when the end effector assembly 602 is displaced to the second deployed position 605 .
- the forward contact surface 640 a of the first protrusion 638 a may be planar and may be normal or substantially normal to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the oblique contact surface 642 a of the first notch 636 a may be planar and may be disposed at an oblique angle relative to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the planar surface of the forward contact surface 640 a of the first protrusion 638 a comes into contact with the planar oblique contact surface 642 a of the first notch 636 a to prevent further bending of the first arm segment 612 a and the second arm segment 614 a about the second hinge 627 a.
- the first mating feature 632 a of the first arm segment 612 a may also include a pair of end surfaces 644 a that may also partially define the first notch 636 a and the second end 620 a of the first arm segment 612 a .
- the first mating feature 634 a of the second arm segment 614 a may include a pair of lateral oblique contact surfaces 646 a that may also partially define the first protrusion 638 a and extend from the first end 625 a (and towards the second end 626 a ) of the second arm segment 614 a .
- the pair of lateral oblique contact surfaces 646 a may be symmetrically disposed about the first protrusion 638 a such that a first of the pair of lateral oblique contact surfaces 646 a may be on a first lateral side of the first protrusion 638 a and a second of the pair of lateral oblique contact surfaces 646 a may be on a second lateral side of the first protrusion 638 a.
- the pair of end surfaces 644 a of the first mating feature 632 a of the first arm segment 612 a may be planar and may be normal or substantially normal to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the lateral oblique contact surface 646 a of the first mating feature 634 a of the second arm segment 614 a may be planar and may be disposed at an oblique angle relative to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the planar pair of end surfaces 644 a comes into contact with the planar lateral oblique contact surfaces 646 a to prevent further bending of the first arm segment 612 a and the second arm segment 614 a about the second hinge 627 a .
- the planar pair of end surfaces 644 a comes into contact with the planar lateral oblique contact surfaces 646 a at the same position as the forward contact surface 640 a of the first protrusion 638 a comes into contact with the planar oblique contact surface 642 a of the first notch 636 a to provide maximum resistance against further bending of the first arm segment 612 a and the second arm segment 614 a about the second hinge 627 a when the end effector assembly 602 is displaced into the second deployed position 605 .
- a second mating feature 648 a of the second arm segment 614 a may engage a corresponding first mating feature 650 a of the third arm segment 616 a (or a corresponding one or more portions of the first mating feature 650 a of the third arm segment 616 a ) to maintain the third arm segment 616 a and the second arm segment 614 a in a desired position when the end effector assembly 602 is in the second deployed position 605 .
- the first mating feature 650 a of the third arm segment 616 a may include a first notch 652 a that may be configured to receive a second protrusion 654 a of the second mating feature 648 a of the second arm segment 614 a .
- a forward contact surface 656 a may define a portion of the second protrusion 654 a
- the forward contact surface 656 a may be configured to contact an oblique contact surface 658 a that defines a portion of the first notch 652 a of the first mating feature 650 a of the third arm segment 616 a when the end effector assembly 602 is displaced to the second deployed position 605 .
- the forward contact surface 656 a of the second protrusion 654 a may be planar and may be normal or substantially normal to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the oblique contact surface 658 a of the first notch 652 a of the first mating feature 650 a of the third arm segment 616 a may be planar and may be disposed at an oblique angle relative to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the planar surface of the forward contact surface 656 a of the second protrusion 654 a comes into contact with the oblique contact surface 658 a of the first notch 652 a of the first mating feature 650 a of the third arm segment 616 a to prevent further bending of the third arm segment 616 a and the second arm segment 614 a about the third hinge 630 a.
- the first mating feature 650 a of the third arm segment 616 a may also include a pair of end surfaces 660 a that may also partially define the first notch 652 a and the first end 628 a of the third arm segment 616 a .
- the second mating feature 648 a of the second arm segment 614 a may include a pair of lateral oblique contact surfaces 662 a that may also partially define the second protrusion 654 a and extend from the second end 626 a (and towards the first end 625 a ) of the second arm segment 614 a .
- the pair of lateral oblique contact surfaces 662 a may be symmetrically disposed about the second protrusion 654 a such that a first of the pair of lateral oblique contact surfaces 662 a may be on a first lateral side of the second protrusion 654 a and a second of the pair of lateral oblique contact surfaces 662 a may be on a second lateral side of the second protrusion 654 a.
- the pair of end surfaces 660 a of the first mating feature 650 a of the third arm segment 616 a may be planar and may be normal or substantially normal to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the lateral oblique contact surface 662 a of the second mating feature 648 a of the second arm segment 614 a may be planar and may be disposed at an oblique angle relative to the first arm axis 610 a when the end effector assembly 602 is in the first undeployed position 603 .
- the planar pair of end surfaces 660 a comes into contact with the planar lateral oblique contact surfaces 662 a to prevent further bending of the third arm segment 616 a and the second arm segment 614 a about the third hinge 630 a .
- the planar pair of end surfaces 660 a comes into contact with the planar lateral oblique contact surfaces 662 a at the same position as the forward contact surface 656 a of the second protrusion 654 a comes into contact with the planar oblique contact surface 658 a of the first notch 652 a to provide maximum resistance against further bending of the third arm segment 616 a and the second arm segment 614 a about the third hinge 630 a when the end effector assembly 602 is displaced into the second deployed position 605 .
- the tissue engaging assembly 600 may include the second tissue engaging arm 604 b that may be identical to the first tissue engaging arm 604 a , and the second tissue engaging arm 604 b may be arranged symmetrical to (i.e., a may be a mirror image of) the first tissue engaging arm 604 a about a plane that extends through a third arm axis 210 c and is parallel to the Y-Z plane of the reference coordinate system of FIGS. 21 B and 22 A .
- features of the second tissue engaging arm 604 b that correspond to features of the first tissue engaging arm 604 a are indicated by reference numbers of the first tissue engaging arm 604 a , but are designated using a “b” suffix instead of the “a” suffix used with the first tissue engaging arm 604 a.
- the second tissue engaging arm 604 b may be elongated and may extend from a first end 606 b to a second end 608 a along a second arm axis 610 b that may be parallel to (or aligned with) the X-axis of the reference coordinate system of FIG. 22 A , and the second arm axis 610 b may be aligned with the first arm axis 610 a .
- the first end 606 a may be coupled to a second portion 211 b of the hub portion 611 .
- the second tissue engaging arm 604 b may include two or more arm segments, and the second tissue engaging arm 604 b may include a first arm segment 612 b , a second arm segment 614 b , and a third arm segment 616 b.
- a first end 618 b of the first arm segment 612 b may be coupled to the second portion 611 b of the hub portion 611 with a first hinge 622 b , which may be a living hinge.
- a first end 625 b of the second arm segment 614 b may be coupled to a second end 620 b of the first arm segment 612 b with a second hinge 627 b , which may be a living hinge.
- a first end 628 b of the third arm segment 616 b may be coupled to a second end 626 b of the second arm segment 614 b with a third hinge 630 b , which may be a living hinge.
- a second end 629 b of the third arm segment 616 b may be coupled to a portion of a second end cap segment 632 b with a fourth hinge 633 b , which may be a living hinge.
- the cross-sectional shape of each of the first arm segment 612 b , the second arm segment 614 b , and the third arm segment 616 b of the second tissue engaging arm 604 b may correspond to the cross-sectional shape of each of the first arm segment 612 a , the second arm segment 614 a , and the third arm segment 616 a of the first tissue engaging arm 604 a , respectively.
- the tissue engaging assembly 600 may include the third tissue engaging arm 604 c and the fourth tissue engaging arm 604 d , which may be identical to the first tissue engaging arm 604 a and the second tissue engaging arm 604 b , respectively. Accordingly, features of the third tissue engaging arm 604 c that correspond to features of the first tissue engaging arm 604 a are indicated by reference numbers of the first tissue engaging arm 604 a , but are designated using a “c” suffix instead of the “a” suffix used with the first tissue engaging arm 604 a .
- features of the fourth tissue engaging arm 604 d that correspond to features of the first tissue engaging arm 604 a are indicated by reference numbers of the first tissue engaging arm 604 a , but are designated using a “d” suffix instead of the “a” suffix used with the first tissue engaging arm 604 a.
- the third tissue engaging arm 604 c and the fourth tissue engaging arm 604 d may be arranged at an angle relative to the first tissue engaging arm 604 a and the second tissue engaging arm 604 b .
- the third tissue engaging arm 604 c may be elongated and may extend from a first end 606 c to a second end 608 c along a third arm axis 610 c
- the fourth tissue engaging arm 604 d may be elongated and may extend from a first end 606 d to a second end 608 d along a fourth arm axis 610 d that may be aligned with the third arm axis 610 c .
- the third arm axis 610 c (and the fourth arm axis 610 d ) may be arranged at an angle (e.g., a right angle) with the first arm axis 610 a (and the second arm axis 610 b ) such that the third arm axis 610 c and the fourth arm axis 610 d are each parallel to (or aligned with) the Y-axis of the reference coordinate system of FIG. 22 A , as illustrated in FIG. 22 A .
- the third tissue engaging arm 604 c may be elongated and may extend from a first end 606 c to a second end 608 c along the third arm axis 610 c .
- the first end 606 c may be coupled to a third portion 611 c of the hub portion 611 .
- the third tissue engaging arm 604 c may include two or more arm segments, and the third tissue engaging arm 604 c may include a first arm segment 612 c , a second arm segment 614 c , and a third arm segment 616 c .
- Each of the first arm segment 612 c , the second arm segment 614 c , and the third arm segment 616 c may be identical (or substantially identical) to the first arm segment 612 a , the second arm segment 614 a , and the third arm segment 616 a , respectively, of the first tissue engaging arm 604 a that was previously described.
- a second end 629 c of the third arm segment 616 c may be coupled to a portion of a third end cap segment 632 c , as previously described.
- the fourth tissue engaging arm 604 d may be elongated and may extend from a first end 606 d to a second end 608 d along the fourth arm axis 610 d .
- the first end 606 d may be coupled to a fourth portion 211 d of the hub portion 611 .
- the fourth tissue engaging arm 604 d may include two or more arm segments, and the fourth tissue engaging arm 604 d may include a first arm segment 612 d , a second arm segment 614 d , and a third arm segment 616 d .
- Each of the first arm segment 612 d , the second arm segment 614 d , and the third arm segment 616 d may be identical (or substantially identical) to the first arm segment 612 b , the second arm segment 614 b , and the third arm segment 616 b , respectively, of the second tissue engaging arm 604 b that was previously described.
- a second end 629 d of the third arm segment 616 d may be coupled to a portion of a fourth end cap segment 632 d , as previously described.
- the end effector assembly 602 may include a housing 664 , and the tissue engaging assembly 600 may be disposed within (or at least partially within) and/or may be coupled to a portion of the housing 664 .
- the housing 664 may be similar to the housing 150 of the embodiment of the end effector 48 previously described (with reference to FIGS. 6 , 8 , and 10 A , for example), and the housing 664 may extend from a proximal end 667 to a distal end 668 along an end effector axis 665 . Similar to the two windows 154 a , 154 b disclosed with reference to the housing 150 (illustrated in FIGS.
- the housing 664 of the current embodiment of the end effector assembly 602 may have two or more windows 666 .
- the housing 664 may have four windows (e.g., a first window 666 a , a second window 666 b , a third window 666 c , and a fourth window 666 d , and each window 666 may be associated (and operatively aligned) with a corresponding one of the first tissue engaging arm 604 a , the second tissue engaging arm 604 b , the third tissue engaging arm 604 b , and the fourth tissue engaging arm 604 d , respectively.
- Each of the first window 666 a , the second window 666 b , the third window 666 c , and the fourth window 666 d may be arrayed in any configuration on the housing 664 .
- each of the first window 666 a , the second window 666 b , the third window 666 c , and the fourth window 666 d may be disposed at even intervals about the effector axis 665 , such as 90 degree intervals, as illustrated in FIG. 26 B .
- any or all of the first window 666 a , the second window 666 b , the third window 666 c , and the fourth window 666 d may be elongated and may extend from a proximal end to a distal end along an axis that is parallel to or substantially parallel to the end effector axis 665 .
- One or more interior surfaces of the housing 664 may define or partially define a housing interior 676 (illustrated in FIG. 26 A ), and each of the two or more windows 666 may extend from an exterior surface defining the housing 664 towards the end effector axis 665 such that each of the two or more windows 666 opens to the housing interior 676 .
- the hub portion 611 of the tissue engaging assembly 600 may be disposed in (or within) the housing interior 676 of the housing 664 at or adjacent to the distal end 668 , and the hub portion 611 may be coupled (or fixedly coupled) to the portion of the housing 664 such that the hub portion 611 remains stationary relative to the housing 664 when the end effector assembly 602 is displaced from the first undeployed position 603 (illustrated in FIG. 25 ) to the second deployed position 605 (illustrated in FIGS. 26 A to 26 C ) and vice versa.
- the hub portion 611 may be coupled to a portion of an end cap 670 coupled to the distal end 668 of the housing 664 , as best illustrated in FIG. 27 showing the end effector assembly 602 with the housing 664 omitted for clarity.
- the end effector assembly 602 may also include a plunger 669 that may be similar or identical to the plunger 30 of the end effector 48 previously described, and the plunger 669 may be directly or indirectly coupled to one of more of the torque links 58 (see FIG. 7 ) and/or to the torque member 202 (see FIG. 11 ) that were previously described.
- the plunger 669 may be disposed at least partially in the housing 664 (i.e., within the housing interior 676 ) at or adjacent to the distal end 668 , and the plunger 669 may be longitudinally displaceable relative to the housing 664 (i.e., displaceable along the end effector axis 665 ) in the same manner as the plunger 30 previously described.
- each of the first end cap segment 632 a of the first tissue engaging arm 604 a , the second end cap segment 632 b of the second tissue engaging arm 604 b , the third end cap segment 632 c of the third tissue engaging arm 604 c , and the fourth end cap segment 632 d of the fourth tissue engaging arm 604 b may be secured to (or within, or partially within) a portion of the plunger 669 to couple the plunger 669 to the tissue engaging assembly 600 .
- each of the first end cap segment 632 a of the first tissue engaging arm 604 a , the second end cap segment 632 b of the second tissue engaging arm 604 b , the third end cap segment 632 c of the third tissue engaging arm 604 c , and the fourth end cap segment 632 d of the fourth tissue engaging arm 604 b may form a pie-shaped wedge (illustrated in FIG. 21 B ) that cooperate to form a disk-shape when assembled, and this disk-shape may be received into a complementary recess formed in the plunger 669 .
- a first position such as a first proximal position (illustrated for plunger 30 in FIG.
- each of the first arm axis 610 a , the second arm axis 610 b , third arm axis 610 c , and fourth arm axis 610 a are parallel or substantially parallel to the end effector axis 665 , and all or a portion of each of the first arm segment 612 a , the second arm segment 614 a , and the third arm segment 616 a may be disposed within the interior portion 676 of the housing 664 (or within an aperture in the housing 664 forming the first window 666 a ).
- the hub portion 611 of the tissue engaging assembly 600 is secured (and/or stationary) at the portion of the housing 664 that is at or adjacent to the distal end 668 , and with the end cap segments 632 a - 632 d of the tissue engaging arms 604 a - 604 d configured to displace distally with the plunger 669 , the tissue engaging arms 604 a - 604 d change in shape from the straight configuration of FIG. 25 to the deployed configuration of FIGS. 26 A to 26 C .
- the first mating feature 632 a of the first arm segment 612 a may engage a corresponding first mating feature 634 a of the second arm segment 614 a to maintain the first arm segment 612 a and the second arm segment 614 a in the desired position when the end effector assembly 602 is in the second deployed position 605 , as previously described.
- the second mating feature 648 a of the second arm segment 614 a may engage a corresponding first mating feature 650 a of the third arm segment 616 a (or a corresponding one or more portions of the first mating feature 650 a of the third arm segment 616 a ) to maintain the third arm segment 616 a and the second arm segment 614 a in a desired position when the end effector assembly 602 is in the second deployed position 605 , also as previously described.
- a second segment axis 671 that extends through the second arm segment 614 a from the first end 625 a to the second end 626 a along the first arm axis 610 a is parallel to the end effector axis 665 and offset from the end effector axis 665 by a first distance D 1 , as illustrated in FIG. 27 .
- a first segment axis 672 that extends through the first arm segment 612 a from the first end 618 a to the second end 620 a is oblique relative to the end effector axis 665 , as illustrated in FIG. 27 .
- the first segment axis 672 may form an angle between 20° and 70° (such as between 35° and 55°) with the end effector axis 665 .
- a third segment axis 674 that extends through the third arm segment 616 a from the first end 628 a to the second end 629 a is oblique relative to the end effector axis 665 , as illustrated in FIG. 27 .
- the third segment axis 674 may form an angle between 20° and 70° (such as between 35° and 55°) with the end effector axis 665 , and this angle may be equal (but oppositely disposed) to the angle formed by the first segment axis 672 and the end effector axis 665 , the third segment axis 674 may be a mirror image of the first segment axis 672 about an axis of symmetry that is normal to the end effector axis 665 .
- the first distance D 1 separating the second segment axis 671 from the end effector axis 665 when the end effector assembly 602 is the second deployed position 605 is greater than a second distance D 2 (illustrated in FIG.
- the second segment axis 671 may be parallel to the end effector axis 665 .
- the first segment axis 672 , the second segment axis 671 , and the third segment axis 674 may all be coaxially aligned and may each be parallel to or substantially parallel to the end effector axis 665 .
- the second arm segment 614 a may be completely external to the housing 664 , while a portion of the first arm segment 612 a may extend through the first window 666 a such that the first end 618 a (see FIG. 24 A ) of the first arm segment 612 a is disposed within the housing interior 676 of the housing 664 (or within the aperture in the housing 664 forming the first window 666 a ) and the second end 620 a of the first arm segment 612 a is disposed external to the housing 664 .
- all or a portion of the first hinge 622 a see FIG.
- the third arm segment 616 a may extend through the first window 666 a such that the second end 629 a (see FIG. 24 A ) of the third arm segment 616 a is disposed within the housing interior 676 of the housing 664 (or within an aperture in the housing 664 forming the first window 666 a ) and the first end 628 a (see FIG.
- the third arm segment 616 a is disposed external to the housing 664 .
- all or a portion of the fourth hinge 633 a may be disposed within the housing interior 676 of the housing 664
- the second end 629 a of the third arm segment 616 a may be disposed exterior to the housing 664 but adjacent (e.g., immediately adjacent to) the aperture in the housing 664 forming the first window 666 a.
- any or all of the second tissue engaging arm 604 b , the third tissue engaging arm 604 b , and the fourth tissue engaging arm 604 d may each displace or transition identically to the first tissue engaging arm 604 a when the end effector assembly 602 is displaced from the first undeployed position 603 to the second deployed position 605 and vice versa, as illustrated in FIGS. 25 to 27 . Accordingly, the first tissue engaging arm 604 a , the second tissue engaging arm 604 b , the third tissue engaging arm 604 b , and the fourth tissue engaging arm 604 d may be disposed physically offset from each other but otherwise in an identical manner in each of the first undeployed position 603 and the second deployed position 605 and any point in between.
- the embodiment of the end effector assembly 602 may be coupled to the handle portion 12 of the tissue manipulation device 10 previously described. However, with reference to FIGS. 28 A to 28 G , the embodiment of the end effector assembly 602 may be coupled to an embodiment of a tissue manipulation device 700 that may have a body portion 702 that may include a grip portion 703 that is configured to be grasped by a single hand of a user during the procedure. In such an embodiment, as illustrated in the cross-sectional view of FIG. 29 B , a portion of the shaft portion 40 at or adjacent to (or distal to) the proximal end 42 of the shaft portion 40 may be coupled to a first portion 704 of the body portion 702 .
- an adjustment wheel 710 may be rotatably coupled to a second portion 705 of the body portion 702 .
- the adjustment wheel 710 may rotate relative to the second portion 705 of the body portion 702 about a wheel axis 709 that may be parallel to the X-axis of the reference coordinate system of FIG. 29 B .
- the adjustment wheel 710 may be similar in form and function to the adjustment wheel 122 previously described, and the adjustment wheel 710 may be coupled to the end effector assembly 602 to rotate the end effector assembly 602 about the end effector axis 665 (see FIG. 28 A ) relative to the distal end 44 of the shaft portion 40 .
- the adjustment wheel 710 may be displaced distally (against the proximally-directed bias force provided by spring 712 ) by the user (not shown) from a locked position (illustrated in FIGS. 30 A and 30 B ) to an unlocked position (illustrated in FIGS. 31 A and 31 B ) to unlock the adjustment wheel 710 and allow the adjustment wheel 710 to rotate about the wheel axis 709 .
- the adjustment wheel 710 may be displaced distally when the user is gripping the grip portion 703 and uses a finger (e.g., a thumb) of the hand gripping the grip portion 703 to unlock and rotate the adjustment wheel 710 .
- the user may release the adjustment wheel 710 which may then be displaced proximally by the spring 712 to the locked position in which the adjustment wheel 710 is unable to rotate.
- the adjustment wheel 710 may include an engagement portion 718 that may be circular or substantially circular in cross-sectional shape, and the engagement portion 718 may have the shape of a disk.
- a portion of the engagement portion 718 may extend out of a housing slot 722 formed in the housing portion 704 .
- a central aperture 724 be formed through the engagement portion 718 , and a plurality of locking slots 714 may extend radially along an inner edge forming the central aperture 724 .
- a post 716 that is adapted to be received into any one of the plurality of locking slots 714 may be secured to a cylindrical hub 726 .
- the cylindrical hub 726 may be fixed relative to the housing portion 704 such that when the post 716 is received into any one of the plurality of locking slots 714 , the adjustment wheel 710 is in the locked position and thus prevented from rotating relative to the cylindrical hub 726 , as illustrated in FIGS. 30 A and 30 B .
- the adjustment wheel 710 is displaced distally (against the proximally-directed bias force provided by spring 712 ) by the user from the locked position to the unlocked position (illustrated in FIGS. 31 A and 31 B )
- the engagement portion 718 displaces distally relative to the post 716 (and the cylindrical hub 726 ) until the post 716 is no longer disposed in any one of the plurality of locking slots 714 .
- the adjustment wheel 710 may be rotated freely about the wheel axis 709 by a user until the user ceases to force the adjustment wheel 710 in a distal direction, at which time the spring 712 displaces the adjustment wheel 710 proximally such that one of the plurality of locking slots 714 that is aligned with the post 716 receives the post 716 to lock the adjustment wheel 710 into the locked position of FIGS. 30 A and 30 B .
- the tissue manipulation device 700 may also have an adjustment member 708 that may be similar in form and identical in function to the adjustment member 22 , and the adjustment member 708 may be coupled to the end effector assembly 602 to transition the end effector assembly 602 between the first undeployed position 603 (illustrated in FIG. 25 ) and the second deployed position 605 (illustrated in FIGS. 26 A to 26 C ).
- the adjustment member 708 may be elongated and extend along a longitudinal axis 741 from a proximal end 734 to a distal end 736 , and the longitudinal axis 741 may be coaxially aligned with the wheel axis 709 .
- An insertion portion 738 may extend from the distal end 736 to an intermediary point 739 , and an input portion 740 may extend proximally from the insertion portion 738 from the intermediary point 739 to the proximal end 734 of the adjustment member 708 .
- the insertion portion 738 may be at least partially received in a central bore 742 of the cylindrical hub 726 , and a threaded portion 744 of an outer surface 746 of the insertion portion 738 may threadedly engage a threaded portion 748 of the central bore 742 of cylindrical hub 726 .
- the adjustment member 708 may be coupled to the end effector assembly 602 by an elongated coupling portion 733 such that displacing the adjustment member 708 displaces the coupling portion 733 and transitions the end effector assembly 602 between the first undeployed position 603 (illustrated in FIG. 29 A ) and the second deployed position 605 (illustrated in FIG. 29 B ).
- the coupling portion 733 may include a wire 732 that may be similar or identical to the wire 52 previously discussed.
- a proximal end 730 of the wire 732 may be secured to a portion of the adjustment member 708 , such as a portion at or adjacent to the distal end 736 of the adjustment member 708 , and a distal end 731 of the wire 732 may be secured to the end effector assembly 602 in any suitable manner, and may be secured to the plunger 669 in the same manner as the distal end 56 of the wire 52 is coupled to the end effector 48 (as illustrated in FIG. 3 ).
- the adjustment member 708 displaces distally along the longitudinal axis 741 from a first adjustment member position (illustrated in FIG. 29 A ) to a second adjustment member position (illustrated in FIG. 29 B ), thereby distally displacing the distal end 731 of the wire 732 to transition the end effector assembly 602 from the first undeployed position 603 (illustrated in FIG. 29 A ) to the second deployed position 605 (illustrated in FIG. 29 B ).
- the adjustment member 708 displaces proximally along the longitudinal axis 741 from the second adjustment member position (illustrated in FIG. 29 B ) to the first adjustment member position (illustrated in FIG. 29 A ), thereby proximally displacing the distal end 731 of the wire 732 to transition the end effector assembly 602 from the second deployed position 605 (illustrated in FIGS. 29 B ) to the first undeployed position 603 (illustrated in FIG. 29 A ).
- the end effector assembly 602 may be transitioned to a semi-deployed position between the first undeployed position 603 and the second deployed position 605 .
- the tissue manipulation device 10 , 700 may include a port 214 configured to deliver fluids to a treatment area.
- the port 214 may extend from a portion of the housing portion 12 , such as a portion of the distal support portion 112 of the wheel housing portion 108 .
- the port 214 may be coupled to a portion of the shaft portion 40 , as illustrated in FIGS. 28 A and 29 A .
- the port 214 may be cylindrical and may extend from an inner end 216 to an outer end 218 along an axis that may be transverse to the longitudinal axis 14 .
- the inner end 216 may be in communication with a chamber 219 within the distal support portion 112 and adjacent to the proximal end 42 of the shaft portion 40 .
- One or more seals may be disposed on the wheel hub 170 to prevent fluid in the chamber 219 from moving proximally.
- the shaft portion 40 may include a plurality of apertures 220 that may be at least partially disposed on the curved portion 142 of the shaft portion 40 . Each of the plurality of apertures 220 extends from the exterior surface 145 of the shaft portion 40 to the shaft interior portion 146 .
- One or more seals may be disposed distal to the plurality of apertures 220 to prevent fluid from moving distal to the one or more seals.
- the fluid when a fluid is introduced into the outer end 218 of the port 214 , the fluid travels through the port 214 and into the chamber 219 , where the fluid enters the shaft interior portion 146 and travels distally towards the plurality of apertures 220 , where the fluid exits each of the plurality of apertures 220 .
- the fluid would flow in any gaps or passages associated with components disposed within the shaft interior portion 146 .
- the fluid would flow through the link bores 286 of the torque links 58 or through gaps between the torque links 58 and portions of the one or more interior surfaces 147 defining the shaft interior portion 146 .
- the outer end 218 of the port 214 may be configured to connect to a source of fluid, and may have a luer fitting, for example.
- the fluid may be a liquid or gas that may be delivered to a treatment area of a patient that is at or adjacent to at least one of the plurality of apertures 220 .
- fluid may also be removed from the treatment area by entering any of the plurality of apertures 220 and exiting the outer end 218 of the port 214 .
- the tissue manipulation device 10 may be fabricated using any suitable material or combination of materials, such as materials that allow for the cleaning and sterilization of all or parts of the tissue manipulation device 10 (e.g., a plastic material or stainless steel).
- a plastic material or stainless steel e.g., a plastic material or stainless steel.
- all or portions of the handle portion 12 , the shaft portion 12 , and the end effector 48 may all be composed or made from stainless steel or plastic.
- the tissue manipulation device 10 , 700 may be used in a prostatectomy procedure.
- the tissue manipulation device 10 , 700 may be inserted transurethral by an operator, e.g., surgeon, into the penis of a patient, and the curved portion 142 of the shaft portion 40 allows the shaft portion 40 to travel along the patient's urethra and past the bony diaphragm structure of the pelvis until the distal end 152 , 668 of the housing 150 , 664 of the end effector 48 , 602 is located in the patient's prostate.
- the adjustment member 22 , 708 may be rotated by the surgeon to drive the tissue engaging members 20 (or the tissue engaging arms 604 ) to extend into the prostate.
- tissue engaging members 20 or the tissue engaging arms 604 ) are shown fully extended, in FIG. 8 , they may be extended to any desired degree by the surgeon between the undeployed position and full extension.
- the prostate's position can then be manipulated as needed to facilitate prostatectomy.
- the positioning of the prostate is provided under control of the surgeon, such as, raised or lowered by adjusting the tilt angle of the shaft portion 40 with respect to the patient's body, pulled or pushed by changing the extent of the shaft portion 40 passing through the urethra (i.e., slightly pushing or pulling the handle potion 12 or grip portion 703 ), and, advantageously, bi-directionally rotated using the adjustment wheel 122 , 710 .
- the surgeon can position the prostate to expose and apply tension to the tissue at the anterior side of the prostate, and thereby locate the area or zone of dissection and proceed to mobilize (or cut the surrounding tissue of) the prostate at its anterior side.
- the prostate's position may then be further manipulated with the tissue manipulation device 10 , 700 to facilitate exposing and placing under tension the area or zone of dissection and proceed to mobilize the tissue (or cut the surrounding tissue) along the posterior side and both lateral sides of the prostate.
- turning the adjustment member 22 , 708 may retract the tissue engaging members 20 (or the tissue engaging arms 604 ).
- the prostate can then be removed from the patient and the urethra sutured to the bladder.
- the tissue manipulation device 10 , 700 thus provides a surgical instrument, which is useful in either open surgery or a laparoscopic prostatectomy, but may also be used in other surgical procedures to manipulate tissue structures other than the prostate via a natural or surgical opening or channel in the body of a patient.
- the control of the prostate's position enabled by the multiple degrees of rotational freedom of the tissue manipulation device 10 allows for precise dissection thereby minimizing the risk of damage to the neurovascular bundles and other tissue about the prostate.
- the tissue manipulation device 10 may be configured for use in a robotic surgical procedure.
- a robot (not shown) with a dynamic member, such as an arm, my interface with an embodiment of the tissue manipulation device 10 to position the tissue manipulation device 10 during the procedure.
- the robot via a first robotic interface 236 (an embodiment of which is illustrated in FIG. 14 A ) be directly or indirectly coupled to the tissue manipulation device 10 to rotate the adjustment wheel 122 (or an equivalent mechanism or gear) to rotate the end effector 48 about the end effector axis 153 relative to the distal end 44 of the shaft portion 40 to precisely position the end effector 48 during a procedure.
- the first robotic interface 236 may be any mechanism, assembly, or device that may interact or interface with the tissue manipulation device 10 to cause the adjustment wheel 122 (or any portion of the rotational assembly coupled to the adjustment wheel 122 ) to rotate.
- the first robotic interface 236 may be a gear 238 that interfaces with the adjustment wheel 122 (or an equivalent gear that acts as the adjustment wheel 122 ) to rotate the adjustment wheel 122 .
- the first robotic interface 236 may include any number or combination of gears to turn the adjustment wheel 122 to a desired position. In other embodiments, such as that of FIG.
- the first robotic interface 236 may be a drive pulley 240 with a belt 242 that is coupled the adjustment wheel 122 to rotate the adjustment wheel 122 .
- the drive pulley 240 and belt 242 may be coupled to a pulley equivalent to the adjustment wheel 122 to rotate the adjustment wheel 122 .
- the robot via a second robotic interface 246 (an embodiment of which is illustrated in FIG. 15 A ), may be directly or indirectly coupled to the tissue manipulation device 10 to displace the wire 52 such that the end effector 48 is displaced from the first undeployed position 49 (illustrated in FIGS. 1 and 6 ) to the second deployed position 51 (illustrated in FIG. 8 ).
- the second robotic interface 246 may be any mechanism, assembly, or device that may interact or interface with the tissue manipulation device 10 to cause (a) the adjustment member 22 (or any portion of the rotational assembly coupled to the adjustment member 22 ) to rotate and/or (b) the wire 52 to longitudinally displace.
- the adjustment member 22 or any portion of the rotational assembly coupled to the adjustment member 22
- the wire 52 to longitudinally displace.
- the second robotic interface 246 may be a gear 248 that interfaces with the adjustment member 22 (or an equivalent gear that acts as the adjustment member 22 ) to rotate the adjustment member 22 .
- the second robotic interface 246 may include any number or combination of gears to turn the adjustment member 22 to a desired position.
- the second robotic interface 246 may be a drive pulley 250 with a belt 252 that is coupled the adjustment member 22 to rotate the adjustment member 22 .
- the robot will include both the first robotic interface 236 and the second robotic interface 246 , or may include either the first robotic interface 236 or the second robotic interface 246 .
- the tissue manipulation device 700 may be configured for use in such a robotic surgical procedure in a similar manner.
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Abstract
A tissue manipulation device includes an end effector assembly disposed at a distal end of a shaft portion, the end effector assembly including a tissue engaging assembly having first and second tissue engaging arms that each include a first arm segment, a second arm segment, and a third arm segment that are coupled by living hinges. When an adjustment member coupled to the end effector assembly is displaced from a first position to a second position, the end effector assembly transition from a first undeployed position, in which the first and second tissue engaging arms are disposed a first configuration adapted for insertion into a patient, to a second deployed position, in which the first and second tissue engaging arms are disposed a second configuration adapted to manipulate a tissue of the patient.
Description
- This application is a continuation-in-part of U.S. patent application Ser. No. 17/945,819, filed on Sep. 15, 2022, which claims the benefit of U.S. Provisional Patent Application No. 63/245,310, filed Sep. 17, 2021, and U.S. Provisional Patent Application No. 63/335,937, filed Apr. 28, 2022, each of which is incorporated by reference herein in its entirety. This application also claims the benefit of U.S. Provisional Patent Application No. 63/352,867, filed Jun. 16, 2022, and U.S. Provisional Patent Application No. 63/424,840, filed Nov. 11, 2022, each of which is incorporated by reference herein in its entirety.
- The claimed invention relates to surgical devices, and more specifically to a tissue manipulation device.
- A prostatectomy is a medical procedure to surgically remove the prostate gland of a male patient. The procedure is often performed due to disease of the prostate, such as cancer. The procedure may be performed by open surgery or laparoscopically by the use of endoscopic instruments through small incisions in the patient. In brief, the prostate is located along the urethra leading to the bladder, and removal of the prostate is performed by exposing the prostate, dissecting the tissue surrounding the prostate, removing the prostate, and then suturing the urethra to the bladder. One problem often encountered during a prostatectomy is that the prostate is difficult to position and maneuver by the surgeon to expose the tissue and place the tissue under tension during dissection to extract the gland. This is especially a problem with a laparoscopic prostatectomy. Another problem is that the neurovascular bundles adjacent to the prostate can be damaged during the prostatectomy negatively affecting normal penile functionality. Precise dissection is important to minimize damage to surrounding tissue and especially the neurovascular bundles. Therefore, it would be desirable to provide an instrument which can be inserted through the urethra to engage the prostate and then enable the prostate's position to be precisely manipulated during a prostatectomy. It would also be desirable to provide a device that may be simple to disassemble for post-procedure cleaning and sterilization.
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FIG. 1 is a perspective view of an embodiment of the tissue manipulation device; -
FIG. 2 is an exploded view of a portion of the embodiment of the tissue manipulation device ofFIG. 1 ; -
FIG. 3 is a cross-sectional view of the embodiment of the tissue manipulation device ofFIG. 1 with a securing member in an engaged position; -
FIG. 4A is a cross-sectional view of the embodiment of the tissue manipulation device ofFIG. 1 with the securing member in an engaged position and in a first securing member position; -
FIG. 4B is a cross-sectional view of the embodiment of the tissue manipulation device ofFIG. 1 with the securing member in an engaged position and in a second securing member position; -
FIG. 5 is a cross-sectional view of the embodiment of the tissue manipulation device ofFIG. 1 with the securing member in a disengaged position; -
FIG. 6 is a cross-sectional view of a distal end of a shaft portion of the embodiment of the tissue manipulation device ofFIG. 1 with the end effector in a first undeployed position; -
FIG. 7 is a perspective of an embodiment of a removable assembly of the tissue manipulation device ofFIG. 1 ; -
FIG. 8 is a cross-sectional view of the distal end of the shaft portion of the embodiment of the tissue manipulation device ofFIG. 1 with the end effector in a second deployed position; -
FIG. 9A is a front view of an embodiment of the securing member; -
FIG. 9B is a front view of the embodiment of the securing member ofFIG. 9A ; -
FIG. 9C is a perspective view of the embodiment of the securing member ofFIG. 9A ; -
FIG. 10A is a top view of the embodiment of the tissue manipulation device ofFIG. 1 ; -
FIG. 10B is a side view of the embodiment of the tissue manipulation device ofFIG. 10A ; -
FIG. 10C is a bottom view of the embodiment of the tissue manipulation device ofFIG. 10A ; -
FIG. 11 is an exploded view of a portion of a further embodiment of the tissue manipulation device; -
FIG. 12 is a cross-sectional view of a shaft portion of the embodiment of the tissue manipulation device ofFIG. 11 ; -
FIG. 13 is a cross-sectional view of the embodiment of the tissue manipulation device ofFIG. 11 ; -
FIG. 14A is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a first robotic interface; -
FIG. 14B is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a first robotic interface; -
FIG. 14C is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a first robotic interface; -
FIG. 15A is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a second robotic interface; -
FIG. 15B is a rear view of an embodiment of the tissue manipulation device coupled to an embodiment of a second robotic interface; -
FIG. 16 is a perspective view of an embodiment of the removable portion of an embodiment of the tissue manipulation device; -
FIG. 17A is a side view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 16 ; -
FIG. 17B is a partial perspective view of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 20A ; -
FIG. 17C is a cross-sectional view of the embodiment of the torque member taken alongsection line 17C-17C inFIG. 17A ; -
FIG. 17D is top view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 16 ; -
FIG. 17E is a cross-sectional view of the embodiment of the torque member taken alongsection line 17E-17E inFIG. 17A ; -
FIG. 18A is a cross-sectional view of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken along the shaft axis; -
FIG. 18B is a cross-sectional view of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken normal to the shaft axis adjacent to a distal end of a linear portion of the shaft portion; -
FIG. 18C includes various cross-sectional views of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken normal to the shaft axis adjacent to a distal end of a linear portion of the shaft portion; -
FIG. 18D is a cross-sectional view of a portion of the shaft portion of an embodiment of the tissue manipulation device, and the cross-sectional view is taken along the shaft axis; -
FIG. 19A is a partial perspective view of an embodiment of a torque member of a removable portion of an embodiment of the tissue manipulation with the shaft portion removed for clarity; -
FIG. 19B is a further partial perspective view of the embodiment of the torque member of the removable portion ofFIG. 19A with the shaft portion removed for clarity; -
FIG. 19C is a cross-sectional view of the embodiment of the torque member taken along section line 19C-19C inFIG. 19D ; -
FIG. 19D is side view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 19A ; -
FIG. 19E is top view of a portion of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 19A ; -
FIGS. 19F to 19H are various partial perspective views of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 19A ; -
FIG. 191 is a front view of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 19A ; -
FIG. 19J is a cross-sectional view of the embodiment of the torque member taken alongsection line 19J-17J inFIG. 17K ; -
FIG. 19K is a perspective view of the embodiment of the torque member of the removable portion ofFIG. 19A ; -
FIG. 20A is a perspective view of an embodiment of the tissue manipulation device with the shaft portion removed for clarity; -
FIG. 20B is a perspective view of a portion of the embodiment of the tissue manipulation device ofFIG. 20A with the shaft portion removed for clarity; -
FIG. 20C is side view of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 20A ; -
FIGS. 20D and 20E are various perspective views of the torque member of the removable portion of the embodiment of the tissue manipulation device ofFIG. 20A ; -
FIG. 20F is a cross-sectional view of the embodiment of the torque member taken alongsection line 20F-20F inFIG. 20C ; -
FIGS. 21A and 21B are a bottom perspective view and a top perspective view, respectively, of an embodiment of a tissue engaging assembly prior to assembly within an end effector assembly; -
FIGS. 22A to 22C are a top view, a first side view, and a second side view, respectively, of the embodiment of the tissue engaging assembly ofFIGS. 21A and 21B ; -
FIG. 23 is a partial perspective view of a first tissue engaging arm of the embodiment of the tissue engaging assembly ofFIGS. 22A to 22C ; -
FIG. 24A is a bottom view of the first tissue engaging arm ofFIG. 23 ; -
FIG. 24B is a cross-sectional view of the first tissue engaging arm taken alongsection line 24B-24B inFIG. 24A ; -
FIG. 25 is a side view of an embodiment of an end effector assembly that includes the embodiment of the tissue engaging assembly ofFIGS. 21A and 21B with the end effector assembly in a first undeployed position; -
FIGS. 26A to 26C are a side view, a top view, and a perspective view, respectively, of the embodiment of the end effector assembly ofFIG. 25 in a second deployed position; -
FIG. 27 is a perspective view of the embodiment of the end effector assembly ofFIG. 25 in the second deployed position with a housing of the end effector assembly removed for clarity; -
FIGS. 28A to 28G are various views of an embodiment of a tissue manipulation device that includes the embodiment of the end effector assembly ofFIG. 25 in the first undeployed position; -
FIG. 29A is a cross-sectional view of the embodiment of the tissue engaging assembly taken alongsection line 29A-29A inFIG. 28B ; -
FIG. 29B is a cross-sectional view of the embodiment of the tissue engaging assembly taken alongsection line 29B-29B inFIG. 28B with the end effector assembly in the second deployed position; -
FIGS. 30A and 30B are a perspective view and a side view, respectively, of the tissue engaging assembly with a portion of the body portion removed for clarity and with an adjustment wheel in a locked position; and -
FIGS. 31A and 31B are a perspective view and a side view, respectively, of the tissue engaging assembly ofFIGS. 30A and 30B with the adjustment wheel in an unlocked position. - Referring to
FIG. 1 , atissue manipulation device 10 includes ahandle portion 12 extending along alongitudinal axis 14 from aproximal end 16 to adistal end 18, and anadjustment member 22 is displaceably coupled to theproximal end 16 of thehandle portion 12. As illustrated in the cross-sectional view ofFIG. 3 , a securingmember 24 is coupled to thehandle portion 12 and the securingmember 24 extends along amember axis 26 from aproximal end 28 to adistal end 29. The securingmember 24 includes anengagement portion 31 disposed at or adjacent to thedistal end 29 of the securingmember 24, and theproximal end 28 of the securingmember 24 is coupled to a portion of theadjustment member 22 such that the securingmember 24 is displaceable along themember axis 26 between a first securing member position 133 (illustrated inFIG. 4A ) and a second securing member position (illustrated inFIG. 4B ). In addition, the securingmember 24 is pivotably coupled to thehandle portion 12 and is pivotably displaceable from between an engaged position 36 (illustrated inFIG. 4A ) and a disengaged position 39 (illustrated inFIG. 5 ). In the engaged position 36, themember axis 26 is parallel to or coaxially aligned with thelongitudinal axis 14, and in thedisengaged position 39, themember axis 26 is not parallel to or coaxially aligned with thelongitudinal axis 14. - Referring again to
FIG. 1 , thetissue manipulation device 10 also includes ashaft portion 40 extending from aproximal end 42 to adistal end 44 along a shaft axis 47 (illustrated inFIG. 10A ), and theproximal end 42 of theshaft portion 40 is coupled to the distal end of thehandle portion 12. Thetissue manipulation device 10 further includes anend effector 48 removably coupled to thedistal end 44 of theshaft portion 40, and the end effector is operable between a first undeployed position 49 (illustrated inFIGS. 1 and 6 ) and a second deployed position 51 (illustrated inFIG. 8 ). - With reference to
FIG. 3 , thetissue manipulation device 10 additionally includes a wire 52 (e.g., a flexible wire 52) extending from aproximal end 54 to a distal end 56 (illustrated inFIG. 8 ), and thedistal end 56 of thewire 52 is coupled to theend effector 48. Theproximal end 54 of thewire 52 is removably coupled to theengagement portion 31 of the securingmember 24 when the securingmember 24 is in the engaged position 36 (illustrated inFIG. 4A ) and theproximal end 54 of the wire is disengaged from theengagement portion 31 of the securingmember 24 when the securingmember 24 is in the disengaged position 39 (illustrated inFIG. 5 ). In addition, when the securingmember 24 is in the engaged position 36 (illustrated inFIG. 4A ), thewire 52 couples the securingmember 24 and theend effector 48 such that (a) when the securingmember 24 is displaced from the first securing member position 133 (illustrated inFIG. 4A ) to the second securing member position 35 (illustrated inFIG. 4B ), theend effector 48 is displaced from the first undeployed position 49 (illustrated inFIGS. 1 and 6 ) to the second deployed position 51 (illustrated inFIG. 8 ) and (b) when the securingmember 24 is displaced from the second securing member position 35 (illustrated inFIG. 4B ) to the first securing member position (illustrated inFIG. 4A ), theend effector 48 is displaced from the second deployed position 51 (illustrated inFIG. 8 ) to the first undeployed position 49 (illustrated inFIGS. 1 and 6 ). - So configured, when the securing
member 24 is in thedisengaged position 39, theend effector 48 may be decoupled from thedistal end 44 of theshaft portion 40 and thewire 52 is configured to be removed from theshaft portion 40 through an aperture 41 (illustrated inFIG. 3 ) defined at thedistal end 44 of theshaft portion 40. Accordingly, thewire 52 and attachedend effector 48 may at least partially define a removable portion 57 (illustrated inFIG. 7 ) that may be separated and removed from thehandle portion 12 andshaft portion 40 to allow the for separate processing (e.g., washing and sterilization) of thehandle portion 12 andshaft portion 40. Theremovable portion 57 may also be processed separately from, or instead of, thehandle portion 12 andshaft portion 40. In some embodiments, theremovable portion 57 may further include one or more components may be coupled to thewire 52 and/or theend effector 58, such as one ormore torque links 58 illustrated inFIG. 7 . - Turning to the
tissue manipulation device 10 in more detail, and with reference toFIGS. 1, 2, and 3 , thehandle portion 12 may extend along thelongitudinal axis 14 from theproximal end 16 to thedistal end 18 and may include agrip portion 59 that may extend along thelongitudinal axis 14 from theproximal end 16 of thehandle portion 12 to adistal end 117 of thegrip portion 59 at a firstintermediary point 60 of thehandle portion 12 that is proximal to thedistal end 18 of thehandle portion 12. Thegrip portion 59 may be shaped and dimensioned to be grasped by the hand of a user during a procedure. Thegrip portion 59 may include a plurality ofslots 61 that each extends parallel to thelongitudinal axis 14 from a point at or distal to theproximal end 16 of thehandle portion 12 to a point at or proximal to the firstintermediary point 60 of thehandle portion 12. The plurality ofslots 61 may be radially arrayed about thelongitudinal axis 14, and the plurality ofslots 61 may cooperate to define a plurality ofridges 62. Correspondingly, the plurality ofridges 62 may be radially arrayed about thelongitudinal axis 14, and each of the plurality ofridges 62 may extend parallel to thelongitudinal axis 14 from a point at or distal to theproximal end 16 of thehandle portion 12 to a point at or proximal to the firstintermediary point 60 of thehandle portion 12. Anouter end surface 63 of each of the plurality ofridges 62 may be contoured or textured to comfortably and securely be grasped by the hand of a user during a procedure. - Referring to
FIGS. 2 and 3 , thehandle portion 12 may further include a central bore 64 that may extend along thelongitudinal axis 14 from theproximal end 16 of thehandle portion 12 to the firstintermediary point 60 of thehandle portion 12 or to a point distal to the firstintermediary point 60 of thehandle portion 12. The central bore 64 may include an end portion 71 and a portion of the end portion 71 may include a threaded portion 72. - Referring to
FIGS. 1 to 3 , thetissue manipulation device 10 may further include theadjustment member 22 which is displaceably coupled to theproximal end 16 of thehandle portion 12. With reference toFIGS. 2 and 3 , theadjustment member 22 may extend along thelongitudinal axis 14 from aproximal end 65 to adistal end 66, and aninsertion portion 67 may extend from thedistal end 66 to anintermediary point 68. Aninput portion 73 may extend proximally from theinsertion portion 67, and theinput portion 73 may extend from theintermediary point 68 to theproximal end 65 of theadjustment member 22. Theinsertion portion 67 may be at least partially received in theend portion 65 of the central bore 64 of thehandle portion 12, and a threadedportion 69 of anouter surface 70 of theinsertion portion 67 may threadedly engage the threaded portion 72 of theend portion 65 of the central bore 64 of thehandle portion 12. Accordingly, when a user rotates the input portion 73 (relative to the handle portion 12) about thelongitudinal axis 14 in a first rotational direction, theadjustment member 22 displaces distally along thelongitudinal axis 14. Correspondingly, when the user rotates the input portion 73 (relative to the handle portion 12) about thelongitudinal axis 14 in a second rotational direction, theadjustment member 22 displaces proximally along thelongitudinal axis 14. - As illustrated in the exploded view of
FIG. 2 , thetissue manipulation device 10 may include the securingmember carrier 74 that may extend from aproximal end 76 to adistal end 78 along an axis that may be along or parallel to thelongitudinal axis 14. The securingmember carrier 74 may include a pair of opposing side walls 80 a, 80 b that may have corresponding inner surfaces that are planar or substantially planar. Apivot post 82 may extend between, and may be fixed relative to, the pair of inner surfaces of the pair of opposing side walls 80 a, 80 b, and thepivot post 82 may extend in a direction that is transverse to thelongitudinal axis 14. Thepivot post 82 may be disposed at any suitable location on the securingmember carrier 74, such as at or adjacent to theproximal end 76 of the securingmember carrier 74, for example. - The securing
member carrier 74 may be displaceably disposed in any suitable portion of the central bore 64 of thehandle portion 12. For example, as illustrated in the cross-sectional view ofFIG. 3 , theproximal end 76 of the securingmember carrier 74 may be distal to the to theproximal end 16 of thehandle portion 12 and thedistal end 78 of the securingmember carrier 74 may be proximal to the to thedistal end 18 of thehandle portion 12. In some embodiments, a portion of theproximal end 76 of the securingmember carrier 74 may be coupled to or in contact with a portion of theadjustment member 22 that is at or adjacent to thedistal end 66 of theadjustment member 22 such that a displacement of theadjustment member 22 along thelongitudinal axis 14 for a first distance in a distal direction will result in a corresponding displacement of the securingmember carrier 74 along thelongitudinal axis 14 for the first distance in the distal direction. Similarly, a displacement of theadjustment member 22 along thelongitudinal axis 14 for a second distance in a proximal direction will result in a corresponding displacement of the securingmember carrier 74 along thelongitudinal axis 14 for the second distance in the proximal direction. - As illustrated in
FIGS. 2, 3, and 9A , thetissue manipulation device 10 may include the securingmember 24 that may extend along themember axis 26 from theproximal end 28 to thedistal end 29. Referring toFIGS. 9A and 9B , the securingmember 24 may be planar or substantially planar, and may be at least partially defined by afirst side surface 84 a and asecond side surface 84 b opposite to thefirst side surface 84 a. Thefirst side surface 84 a and thesecond side surface 84 b may be separated by a constant width, and the width may be less than the distance separating the pair of inner surfaces of the pair of opposing side walls 80 a, 80 b of the securing member carrier 74 (illustrated inFIG. 2 ) such that all or a portion of the securingmember 24 may be disposed between the pair of inner surfaces of the pair of opposing side walls 80 a, 80 b of the securingmember carrier 74 when the securingmember 24 is in the engaged position 36 (illustrated inFIG. 4A ). - Still referring to
FIG. 9A , the securingmember 24 may include ashaft portion 86 that may extend along themember axis 26 from theproximal end 28 of the securingmember 24 to anintermediate point 88. A lateral portion 90 may extend distally from theshaft portion 86, and may extend along an axis that is parallel to and offset from themember axis 26 from a point aligned with theintermediate point 88 to a point at or adjacent to thedistal end 29 of the securingmember 24. Asupport arm 92 may extend from a distal portion of the lateral portion 90 that is at or adjacent to thedistal end 29 of the securingmember 24. In particular, thesupport arm 92 may extend inwardly (i.e., towards the member axis 26) from a portion of an inner lateral edge 102 of the lateral portion 90 that is proximal to thedistal end 29 of the securingmember 24. Thesupport arm 92 may extend along an axis that is transverse (or substantially transverse) to themember axis 26. Theengagement portion 31 that is adapted to couple to theproximal end 54 of the wire 52 (as illustrated inFIG. 3 ) may be disposed on a portion of thesupport arm 92, such as a portion at or adjacent to an end portion of thesupport arm 92. Theengagement portion 31 may be any feature that may removably coupled to theproximal end 54 of thewire 52, such as a slot or a yoke feature. In other embodiments, such as embodiments not having asupport arm 92, theengagement portion 31 may be disposed at any suitable portion of the securingmember 24, such as a portion of the securingmember 24 that is at or adjacent to thedistal end 29 of the securingmember 24. - The securing
member 24 may also include astop arm 94 that may extend from a portion of the lateral portion 90 that is proximal to thedistal end 29 of the securingmember 24. In particular, thestop arm 94 may extend inwardly extend from a portion of the inner lateral edge 102 of the lateral portion 90 that is proximal to thedistal end 29 of the securingmember 24. Thestop arm 94 may extend along an axis that is transverse (or substantially transverse) to themember axis 26, and this axis may be parallel or substantially parallel to the axis of thesupport arm 92 such that thestop arm 94 is proximally offset from the axis of the support arm 92 (e.g., offset in direction extending along themember axis 26 towards theproximal end 28 of the securing member 24). Thestop arm 94 may be positioned on the securingmember 24 such that a portion of a lower surface of thestop arm 94 may contact a portion of a stop post 96 (illustrated inFIG. 3 ) when the securingmember 24 is in the first securing member position (illustrated inFIG. 4A ) to prevent further proximal displacement of the securingmember 24. Thestop post 96 may extend in a direction that is transverse to the longitudinal axis 14 (and parallel to the pivot post 82), and the stop post may be fixedly coupled to a portion of thehandle portion 12 in any suitable location to allow for the contact between the portion of the lower surface of thestop arm 94 and the portion of thestop post 96 when the securingmember 24 is in the first securing member position (illustrated inFIG. 4A ) The stop arm may have acurved end 95 that may be configured to contact thestop post 96 to prevent further pivoting of the securingmember 24 relative to thehandle member 12. - The securing
member 24 may additionally include aresilient member 98 that may be coupled to or integrally formed with the securingmember 24. For example, theresilient member 98 may be spring that extends along (or parallel to) themember axis 26 and may expand and retract along (or parallel to) themember axis 26. Theresilient member 98 may include a plurality of parallel portions disposed transverse to themember axis 26, and ends of the parallel portions are coupled by alternating curved portions. A first end portion 99 of theresilient member 98 may be configured to be in contact with thestop post 96 when the securingmember 24 is in the engaged position 36 (illustrated inFIG. 4A ) and the first end portion 99 of theresilient member 98 may be configured to not contact thestop post 96 when the securingmember 24 is pivoted to the disengaged position 39 (illustrated inFIG. 5 ). While theresilient member 98 has been described as integrally formed with the securingmember 24, in some embodiments, theresilient member 98 may be coupled to any suitable portion of the securingmember 24. - The securing
member 24 may be pivotably or rotatably coupled to the securingmember carrier 74 in any suitable manner. For example, apivot aperture 100 may be disposed in a portion of the securingmember 24 at or adjacent to theproximal end 28 of the securingmember 24, such as a portion of theshaft portion 86 that is at or adjacent to theproximal end 28 of the securingmember 24. The pivot post 82 of the securingmember carrier 74 may be disposed through thepivot aperture 100 such that the securingmember 24 is pivotably displaceable about thepivot post 82 between the engaged position 36 (illustrated inFIG. 4A ) and the disengaged position 39 (illustrated inFIG. 5 ). The securingmember 24 may be pivoted (for example, about the pivot post 82) to any suitable degree such that theengagement portion 31 of the securingmember 24 may be disengaged or decoupled from theproximal end 54 of thewire 52. As such, when in thedisengaged position 39, themember axis 26 of the securingmember 24 may form an angle between 1° degree and 180° with thelongitudinal axis 14 to allow theengagement portion 31 of the securingmember 24 to disengage or decouple from theproximal end 54 of thewire 52. - Because the securing
member 24 is fixedly coupled to the securingmember carrier 74 by thepivot post 82 in the engaged position 36, the securingmember 24 may translate with the securingmember carrier 74 along thelongitudinal axis 14 when the securingmember carrier 74 is longitudinally displaced by theadjustment member 22, as previously described. In addition, because the first end portion 99 of theresilient member 98 of the securingmember 24 is in contact with thestop post 96 coupled to thehandle portion 12, theproximal end 76 of the securingmember carrier 74 is biased into engagement with thedistal end 66 of theadjustment member 22. Theresilient member 98 also biases theengagement portion 31 of the securing member 24 (which is coupled to theproximal end 54 of the wire 52) toward theproximal end 16 of thehandle portion 12, which maintains tension in thewire 52. - The securing
member 24 may also include a grip tab 104 that may facilitate the grasping of the securingmember 24 by a user to pivot the securingmember 24 from the engaged position 36 thedisengaged position 39, and vice versa. The grip tab 104 may extend from a portion of the lateral portion 90 that is proximal to thedistal end 29 of the securingmember 24, and the grip tab 104 may extend outwardly from a portion of an outer lateral edge 106 of the lateral portion 90 that is proximal to thedistal end 29 of the securingmember 24. - Turning again to the
handle portion 12 of thetissue manipulation device 10,FIG. 1 illustrates an embodiment in which thehandle portion 12 includes awheel housing portion 108 that is distal to thedistal end 117 of thegrip portion 59 and coupled to or integrally formed with thedistal end 117 of thegrip portion 59. With reference toFIG. 3 , thewheel housing portion 108 may include aproximal support portion 110 and adistal support portion 112. Theproximal support portion 110 may be cylindrical or substantially cylindrical and may extend along thelongitudinal axis 14 from aproximal end 114 to adistal end 116. Theproximal end 114 may be coupled to or integrally formed with thedistal end 117 of thegrip portion 59, and one or more interior surfaces of theproximal support portion 110 may cooperate to form a portion of the central bore 64 of thehandle portion 12. - The
distal support portion 112 may be distal to and longitudinally offset from theproximal support portion 110. Thedistal support portion 112 may be cylindrical or substantially cylindrical and may extend along thelongitudinal axis 14 from aproximal end 118 to adistal end 120. In embodiments including thewheel housing portion 108, thedistal end 120 of thedistal support portion 112 may be disposed at or correspond to the distal end of thehandle portion 12. One or more interior surfaces of thedistal support portion 112 may cooperate to form a portion of the central bore 64 of thehandle portion 12. Anadjustment wheel 122 may be disposed in the space between theproximal end 118 of thedistal support portion 112 and thedistal end 116 of theproximal support portion 110, and theadjustment wheel 122 will be discussed in more detail below. - As illustrated in
FIG. 2 , aguard portion 124 may couple theproximal support portion 110 and thedistal support portion 112. In particular, theguard portion 124 may include afirst arm 126 having a first distal portion 127 extending from a portion of thedistal support portion 112 along an axis that is substantially transverse to thelongitudinal axis 14. Thefirst arm 126 may also include a firstproximal portion 128 extending from a portion of theproximal support portion 110 along an axis that is substantially transverse to the longitudinal axis. A firstlateral portion 130 may extend between an end portion of the first distal portion 127 and an end portion of the firstproximal portion 128. - The
guard portion 124 may further include asecond arm 132 having a seconddistal portion 134 extending from a portion of thedistal support portion 112 along an axis that is substantially transverse to thelongitudinal axis 14. Thesecond arm 132 may also include a secondproximal portion 136 extending from a portion of theproximal support portion 110 along an axis that is substantially transverse to thelongitudinal axis 14. A secondlateral portion 138 may extend between an end portion of the seconddistal portion 134 and an end portion of the secondproximal portion 136. Thesecond arm 132 may be symmetrical to thefirst arm 126 about a plane extending along thelongitudinal axis 14. So configured, with theadjustment wheel 122 disposed in the space between theproximal end 118 of thedistal support portion 112 and thedistal end 116 of theproximal support portion 110, thefirst arm 126 and thesecond arm 132 of theguard portion 124 surround theadjustment wheel 122 to protect against unwanted rotation due to inadvertent contact with theadjustment wheel 122. - Referring now to
FIG. 10A , thetissue manipulation device 10 also includes theshaft portion 40 extending from theproximal end 42 to thedistal end 44 along theshaft axis 47. Theproximal end 42 of theshaft portion 40 may be coupled to thedistal end 18 of thehandle portion 12. In embodiments including thewheel housing portion 108, theproximal end 42 of theshaft portion 40 may be coupled to thedistal end 120 of the distal support portion 112 (illustrated inFIG. 3 ). However, theproximal end 42 of theshaft portion 40 may be coupled to any suitable portion of theshaft portion 40, such as thedistal end 117 of the grip portion 59 (illustrated inFIG. 1 ) in embodiments that do not include thewheel housing portion 108. Thedistal end 44 of theshaft portion 40 may be removably coupled to a portion of theend effector 48. - The
shaft portion 40 may have any suitable shape or combination of shapes. For example, theshaft portion 40 may include alinear portion 140 and acurved portion 142. Thelinear portion 140 may extend from theproximal end 42 of the shaft portion to anintermediate point 144 of theshaft portion 40. The portion of theshaft axis 47 that extends along thelinear portion 140 may be aligned with thelongitudinal axis 14 or may be parallel to thelongitudinal axis 14. In some embodiments, the portion of theshaft axis 47 that extends along thelinear portion 140 may form an angle (i.e., an acute angle) with thelongitudinal axis 14. Thecurved portion 142 of theshaft portion 40 may extend from theintermediate point 144 of theshaft portion 40 to thedistal end 44 of theshaft portion 40. In some embodiments, thecurved portion 142 may be linear and the portion of theshaft axis 47 that extends along thecurved portion 142 may form an angle (i.e., an acute angle) with thelongitudinal axis 14 and/or with the portion of theshaft axis 47 that extends along thelinear portion 140. In other embodiments, theshaft portion 40 may not have acurved portion 142 and thelinear portion 140 may extend from theproximal end 42 of theshaft portion 40 to thedistal end 44 of theshaft portion 40. In still further embodiments, theshaft portion 40 may not have alinear portion 140 and thecurved portion 142 may extend from theproximal end 42 of theshaft portion 40 to thedistal end 44 of theshaft portion 40. - As illustrated in
FIG. 3 , theshaft portion 40 may have one or moreexterior surfaces 145 and may have one or moreinterior surfaces 147 that define a shaftinterior portion 146. The shaftinterior portion 146 may open into, be in communication, and/or be aligned with the central bore 64 of thehandle portion 12. The one or moreexterior surfaces 145 and one or moreinterior surfaces 147 may have any suitable cross-sectional shape of combination of shapes. For example, the one or moreexterior surfaces 145 and/or the one or moreinterior surfaces 147 may have a circular (or polygonal) cross-sectional shape. The cross-sectional shape of any of the one or moreexterior surfaces 145 and/or the one or moreinterior surfaces 147 may be uniform along theentire shaft portion 40 or along one or more segments of the shaft portion 40 (e.g., the linear portion 140). - With reference to
FIG. 3 , thetissue manipulation device 10 additionally includes thewire 52 that extends from theproximal end 54 to the distal end 56 (illustrated inFIG. 8 ), and thedistal end 56 of thewire 52 may be coupled to a portion of theend effector 48, such as aproximal portion 148 of theend effector 48. All or a portion of thewire 52 may be flexible to allow thewire 52 to extend through thecurved portion 142 of theshaft portion 40. Thewire 52 may be a single unitary part or may be an assembly of two or more segments and/or components. For example, as illustrated inFIG. 3 , thewire 52 may include acoupling portion 52 a disposed at or adjacent to theproximal end 54 of thewire 52. As illustrated inFIG. 3 , theproximal end 54 of thewire 52 may be removably coupled to theengagement portion 31 of the securingmember 24 when the securingmember 24 is in the engaged position 36 (illustrated inFIG. 4A ), and theproximal end 54 of thewire 52 may be shaped or dimensioned to be removably engaged by theengagement portion 31 of the securingmember 24. - As illustrated in
FIGS. 1 , thetissue manipulation device 10 additionally includes theend effector 48 removably and rotatably coupled to thedistal end 44 of theshaft portion 40, and the end effector is operable between a first undeployed position 49 (illustrated inFIGS. 1 and 6 ) and a second deployed position 51 (illustrated inFIG. 8 ). Thedistal end 56 of thewire 52 may be coupled to theproximal portion 148 of theend effector 48 such that when the securingmember 24 is displaced (e.g., displaced distally in a direction along the member axis 26) from the first securing member position (illustrated inFIG. 4A ) to the second securing member position 35 (illustrated inFIG. 4B ), theend effector 48 is transitioned (e.g., expanded or deployed) from the first undeployed position 49 (illustrated inFIGS. 1 and 6 ) to the second deployed position 51 (illustrated inFIG. 8 ). Correspondingly, when the securingmember 24 is displaced (e.g., displaced proximally in a direction along the member axis 26) from the second securing member position 35 (illustrated inFIG. 4B ) to the first securing member position 133 (illustrated inFIG. 4A ), theend effector 48 is transitioned (or contracted) from the second deployed position 51 (illustrated inFIG. 8 ) to the first undeployed position 49 (illustrated inFIGS. 1 and 6 ). - Turning to the
end effector 48 in more detail,FIG. 10A illustrates an embodiment of theend effector 48 having ahousing 150 that extends from aproximal end 151 to adistal end 152 along anend effector axis 153, and twowindows housing 150. As shown in the cross-sectional view ofFIG. 8 , thehousing 150 includes a plurality of interior surfaces that cooperate to define acavity 156 within thehousing 150. In thecavity 152, disposed for extension through each of thewindows sets tissue engaging members 20. Thetissue engaging members 20 are extendible from the first undeployed position 49 (illustrated inFIGS. 1 and 6 ) to the second deployed position 51 (illustrated inFIG. 8 ). In each ofsets tissue engaging members 20 is formed by aproximal member 20 a and adistal member 20 c, and the second of the twotissue engaging members 20 is formed by aproximal member 20 b and adistal member 20 d. - Each
tissue engaging member 20 represents a hinged wing which is extendible radially through theirrespective windows proximal member 20 a has asocket 33 which receives a curved member or shaft extending from thedistal member 20 c to form a hinge similar to a ball and socket joint. One side of thesocket 33 extends to form afinger 34 which may be received in anopening 37 ofdistal member 20 c shaped to receivefinger 34.Proximal member 20 a has abarb 38 which extends from the other side of thesocket 33. Similarly, theproximal member 20 b has a curved member orshaft 226 which is received insocket 43 ofdistal member 20 d to form a hinge also similar to a ball and socket joint. One side of thesocket 43 extends to form a finger 228 which may be received in anopening 45 ofproximal member 20 b shaped to receive finger 228.Proximal member 20 d has a barb 46 which extends from the other side ofsocket 43.Proximal member 20 a anddistal member 20 d may be of the same first length, andproximal member 20 b anddistal member 20 c may be of the same second length, where the first length is less than the second length. Thesecond set 21 b is a mirror image of the first set 21 a, and operates identically to the first set 21 a. - In the first set 21 a, a
hole 230 is provided at theend 230 ofdistal member 20 c through which extends apin 50 through two openings in the sides ofhousing 150 near thedistal end 152, and a hole is also provided at end ofdistal member 20 d through which thepin 50 also extends. In thesecond set 21 b, apin 53 similarly extends through holes 233 through two openings in the sides ofhousing 150 near thedistal end 152. Each ofpins windows - As illustrated in
FIG. 8 , theend effector 48 also includes aplunger 30 disposed at least partially in thehousing 150 at or adjacent to thedistal end 152 of thehousing 150, and theplunger 30 is longitudinally displaceable relative to thehousing 150. In particular, aproximal end 158 of theplunger 30, which may correspond to (or be at or adjacent to) theproximal portion 148 of theend effector 48, may be coupled to thedistal end 56 of thewire 52. Theproximal end 158 of theplunger 30 may be coupled to thedistal end 56 of thewire 52 in any suitable manner. For example, thedistal end 56 of thewire 52 may include an enlarged portion 160 (such as a ball end) that is disposed within acavity 162 formed in a portion of theplunger 30. Thus, a distal displacement of thedistal end 56 of thewire 52 results in a distal displacement of theplunger 30 with respect to thehousing 150, and a proximal displacement of thedistal end 56 of thewire 52 results in a proximal displacement of theplunger 30 with respect to thehousing 150. In addition, theenlarged portion 160 and thecavity 162 are shaped and dimensioned configured to allow the plunger 30 (and the entire housing 150) to rotate relative to thedistal end 56 of thewire 52. - The
plunger 30 additionally includes twoplunger sockets distal end 164 of theplunger 30. At end 49 aopposite socket 33 ofproximal member 20 a forms a curved member or shaft 32 a, and at end 49 b oppositepin 42 ofproximal member 20 b forms a curved member orshaft 32 b. For tissue engaging member set 21 a,curved members 32 a and 32 b ofproximal members plunger socket 30 c and are rotatable therein. For tissue engaging member set 21 b, curvedmembers 32 a and 32 b ofproximal members plunger socket 30 d and are rotatable therein. Thewalls 30 f forming theplunger sockets curved members 32 a and 32 b in one of theplunger sockets curved members 32 a and 32 b may inserted or removed from these sockets only at an angle not achievable when the distal end is fully assembled, thereby preventing thecurved members 32 a and 32 b from falling out of their respective sockets during normal operation. - As the
plunger 30 moves distally in thehousing 150 towards thedistal end 152, thecurved members 32 a and 32 b rotate inplunger socket 30 c (for tissue engaging member set 21 a) or 30 d (for tissue engaging member set 21 b), rotatingcurved members 36 and 42 of distal andproximal members sockets distal members distal members distal end 16 simultaneously bothsets tissue engaging members 20. The degree of extension being controlled by the length of travel of the longitudinal drive mechanism and limited byfingers distal members openings proximal members plunger 30 moves towards theproximal end 151 of thehousing 150, the above-described outward rotation ofmember 20 a-d occurs in the opposite direction, thereby retracting thetissue engaging members 20. The degree of retracting may be controlled by the length of travel of theplunger 30 and limited by thesurface 38 a ofbarb 38 ofproximal member 20 a abutting the surface 23 b ofdistal member 20 c, and the surface 46 a of barb 46 ofdistal member 20 d abutting the surface 25 ofproximal member 20 b. When fully retracted, thetissue engaging members 20 are substantially contained in thehousing 150, and may extend slightly beyond the outer perimeter of thehousing 150, as shown inFIG. 6 . - Accordingly, when a user rotates the
adjustment member 22 relative to thehandle portion 12 such that theadjustment member 22 translates distally, the securingmember carrier 74 also moves distally, thereby translating the securingmember 24 from the first securing member position 133 (illustrated inFIG. 4A ) to the second securing member position 35 (illustrated inFIG. 4B ). As the securingmember 24 displaces from the first securing member position 133 to the second securing member position 35, thedistal end 56 of thewire 52 is displaced distally, thereby moving theplunger 30 distally within thehousing 150 of theend effector 48, and theend effector 48 is displaced from the first undeployed position 49 (illustrated inFIGS. 1 and 6 ) to the second deployed position 51 (illustrated inFIG. 8 ). - Conversely, when a user rotates the
adjustment member 22 relative to thehandle portion 12 such that theadjustment member 22 translates proximally, the securingmember carrier 74 also moves proximally (as illustrated inFIG. 4B , due to the bias caused by the first end portion 99 of theresilient member 98 of the securingmember 24 that is in contact with the stop post 96), thereby translating the securingmember 24 from the second securing member position 35 (illustrated inFIG. 4B ) to the first securing member position 133 (illustrated inFIG. 4A ). As the securingmember 24 displaces from the second securing member position 35 to the first securing member position 133, thedistal end 56 of thewire 52 is displaced proximally, thereby moving theplunger 30 proximally within thehousing 150 of theend effector 48, and theend effector 48 is displaced from the second deployed position 51 (illustrated inFIG. 8 ) to the first undeployed position 49. - While the embodiment of the
end effector 48 has been described as having twosets tissue engaging members 20 that are extendible from the first undeployed position 49 to the second deployedposition 51, other embodiments of the end effector are contemplated. In some of the other embodiments, theend effector 48 may be configured to extend, retract, or change position from a first position to a second position (and, optionally, further positions). In other embodiments, theend effector 48 may have a fixed configuration and not transition from a first position to a second position, - In some embodiments, the
end effector 48 may be rotatable relative to theshaft portion 40 during a procedure, providing the user with an advantageous additional rotational degree of freedom. In such embodiments, theadjustment wheel 122, which may be disposed in the space between theproximal end 118 of thedistal support portion 112 and thedistal end 116 of theproximal support portion 110, may be coupled to theend effector 48 to rotate theend effector 48 relative to theshaft portion 140. - In particular, as illustrated in
FIG. 2 , theadjustment wheel 122 may have acentral aperture 166 that may be adapted to be disposed around anouter surface 168 of awheel hub 170. Thecentral aperture 166 may have a non-circular shape that may correspond to a non-circular shape of theouter surface 168 of thewheel hub 170 such that when theadjustment wheel 122 is rotated, thewheel hub 170 correspondingly rotates relative to the handle portion 12 (and the shaft portion 40). Thewheel hub 170 may be elongated and may extend along a hub axis from aproximal end 172 to adistal end 174, and the hub axis may be aligned with thelongitudinal axis 14. So configured, and as illustrated inFIG. 4B , all or a portion of a proximal portion 176 of thewheel hub 170 may be disposed through (and may be rotatable within) theproximal support portion 110 of thewheel housing portion 108 of thehandle portion 12, and all or a portion of adistal portion 178 of thewheel hub 170 may be disposed through (and may be rotatable within) thedistal support portion 112 of thewheel housing portion 108 of thehandle portion 12. Thewheel hub 170 may be maintained in proper longitudinal alignment by a plurality of Belleville springs 180 that are disposed between a proximal surface of thedistal support portion 112 and a surface of theadjustment wheel 122, which is fixed to thewheel hub 170. - Still referring to
FIG. 4B , thewheel hub 170 may have acentral aperture 171 that extends through thewheel hub 170 from theproximal end 172 to thedistal end 174 along the hub axis, and thecentral aperture 171 is in communication with the central bore 64 of thehandle portion 12 As such, a portion of thewire 52 may be disposed through, and may displace longitudinally within, thecentral aperture 171 of thewheel hub 170. A plurality ofgear teeth 182 may be disposed about a circumferential surface at thedistal end 174 of thewheel hub 170 surrounding thecentral aperture 171, and the plurality ofgear teeth 182 rotate about thelongitudinal axis 14 as theadjustment wheel 122 is rotated. - Referring now to
FIG. 7 , theremovable portion 57 of thetissue manipulation device 10 may include two ormore torque links 58 that cooperate to rotatably couple theadjustment wheel 122 and theend effector 48. The two ormore torque links 58 may include afirst torque link 58 a that may be rotatably coupled to thewheel hub 170. In particular, as illustrated inFIG. 2 , thefirst torque link 58 a may be elongated and may extend along an axis from aproximal end 182 a to adistal end 184 a, and a link bore 186 a may extend through thefirst torque link 58 a from theproximal end 182 a to thedistal end 184 a. As such, a portion of thewire 52 may be disposed through, and may displace longitudinally within, the link bore 186 a. A plurality ofgear teeth 188 a may be disposed about a circumferential surface at thedistal end 184 a of thefirst torque link 58 a surrounding the link bore 186 a. In addition, a plurality of receivingnotches 190 a may be disposed about a circumferential surface at theproximal end 182 a of thefirst torque link 58 a surrounding the link bore 186 a. When theremovable portion 57 is secured to thehandle portion 12 and theshaft portion 40 of thetissue manipulation device 10, and when the securingmember 24 is in the engaged position 36 (illustrated inFIG. 4A ), each of the plurality of receivingnotches 190 a of thefirst torque link 58 a may engage a corresponding one of the plurality ofgear teeth 182 of thewheel hub 170 such that a rotation of thewheel hub 170 causes a corresponding rotation of thefirst torque link 58 a. - Each of the two or
more torque links 58 of theremovable portion 57 may be identical. For example, the two ormore torque links 58 may also include asecond torque link 58 b that may be identical to thefirst torque link 58 a. That is, thesecond torque link 58 b may be elongated and may extend along an axis from aproximal end 182 b to adistal end 184 b, and a link bore 186 b may extend through thesecond torque link 58 b from theproximal end 182 b to thedistal end 184 b. As such, a portion of thewire 52 may be disposed through, and may displace longitudinally within, the link bore 186 b. A plurality ofgear teeth 188 b may be disposed about a circumferential surface at thedistal end 184 b of thesecond torque link 58 b surrounding the link bore 186 b. In addition, a plurality of receivingnotches 190 b may be disposed about a circumferential surface at theproximal end 182 b of thesecond torque link 58 b surrounding the link bore 186 b. When theremovable portion 57 is secured to thehandle portion 12 and theshaft portion 40 of thetissue manipulation device 10, and when the securingmember 24 is in the engaged position 36 (illustrated inFIG. 4A ), thesecond torque link 58 b may be disposed distal to thefirst torque link 58 a such that each of the plurality ofgear teeth 188 a of thefirst torque link 58 a may engage a corresponding one of the plurality of receivingnotches 190 b of thesecond torque link 58 b such that a rotation of thefirst torque link 58 a causes a corresponding rotation of thesecond torque link 58 b. - In some embodiments, the
removable portion 57 may include any number ofadditional torque links 58, which may include the most distal torque link 58 z. Distal torque link 58 z may be identical to the first and second torque links 58 a, 58 b, and all other includedtorque links 58. As such, when thefirst torque link 58 a is rotated by a corresponding rotation of theadjustment wheel 122, thesecond torque link 58 b is also rotated as previously described, and the chain reaction of rotation would also rotate the distal torque link 58 z. When the distal torque link 58 z rotates, thegear teeth 188 z of the distal torque link 58 z also rotate, as would be understood by one having ordinary skill in the art. Thegear teeth 188 z of the distal torque link 58 z engage corresponding receivingnotches 192 on a proximal end of aconnector portion 194 of theend effector 48. Theconnector portion 194 is fixedly coupled to thehousing 150 of theend effector 48, and when the distal torque link 58 z rotates from rotation of theadjustment wheel 122 as previously described, theend effector 40 also rotates relative to theshaft portion 40 about theend effector axis 153. - In some embodiments, the two or
more torque links 58 include only two torque links, so thesecond torque link 58 b corresponds to the distal torque link 58 z. In other embodiments, the orientation of the on thegear teeth 188 a and the receivingnotches 190 a previously described may be reversed. For example, theproximal end 182 of thefirst torque link 58 a may have thegear teeth 188 a and thedistal end 184 a of thefirst torque link 58 a may include the receivingnotches 190 a, and allother torque links 58 and associated components may also be reversed. In other embodiments, thegear teeth 188 a and the receivingnotches 190 a may be identical features such that the orientation of the torque links 58 along thewire 52 of theremovable portion 57 does not matter. - As illustrated in
FIG. 7 , theremovable portion 57 may include the two or more torque links 58 (for example, sixteen torque links 58), and a portion of thewire 52 may extend through the link bore 186 of each of the two or more torque links 58. In some embodiments, theremovable portion 57 may also include aspring 196 that may surround a portion of thewire 52, and the spring may extend from aproximal end 197 to adistal end 198 along an axis aligned with the portion of thewire 52. Theproximal end 197 of thespring 196 may be coupled to a portion of thewire 52 adjacent to theproximal end 54 of thewire 52, such as a distal end of thecoupling portion 52 a disposed at or adjacent to theproximal end 54 of thewire 52. - The
distal end 198 of thespring 196 may be directly or indirectly coupled to theproximal end 182 a of thefirst torque link 58 a. In some embodiments, thedistal end 198 of thespring 196 may be coupled to a proximal end of acylindrical member 199, and the distal end of thecylindrical member 199 may be in contact with a portion of theproximal end 182 a of thefirst torque link 58 a. So positioned, the spring 195 operates to bias thefirst torque link 58 a towards thedistal end 56 of thewire 52, which biases thedistal end 184 a of thefirst torque link 58 a into engagement with theproximal end 182 b of thesecond torque link 58 b, which similarly biases each of the remainingtorque links 58 distally such that thegear teeth 188 z at the distal end 184 z of the distal torque link 58 z is biased into engagement with the corresponding receivingnotches 192 on the proximal end of theconnector portion 194 of theend effector 48. - Accordingly, when the securing
member 24 is pivoted from the engaged position 36 (illustrated inFIG. 4A ) to the disengaged position 39 (illustrated inFIG. 5 ), theremovable portion 57 may be removed from theshaft portion 40 and handleportion 12. In some embodiment, a locking mechanism (not shown), such as a pin extending through an aperture, may couple theend effector 48 to thedistal end 44 of theshaft portion 40, and this locking mechanism should be disabled (e.g., by removing the pin) prior to removing theremovable portion 57. Once theend effector 48 is no longer secured to thedistal end 44 of theshaft portion 40, theend effector 48 may be grasped by a user and displaced along theend effector axis 153 away from thedistal end 44 of theshaft portion 40 until aproximal end 200 of theremovable portion 57, which may be theproximal end 54 of thewire 52, extends past thedistal end 44 of theshaft portion 40. One having ordinary skill in the art would recognize that theremovable portion 57 would be bendable between any twoadjacent torque links 58, and this ability to bend allows the chain oftorque links 58 allows theremovable portion 57 to be passed through thecurved portion 142 of theshaft portion 40 when inserting or removing theremovable portion 57 for disassembly or reassembly. - Once the
removable portion 57 has been removed from thehandle portion 12 andshaft portion 40, thehandle portion 12 andshaft portion 40 may undergo a process (e.g., washing and sterilization). Alternatively, theremovable portion 57 may also be processed separately from, or instead of, thehandle portion 12 andshaft portion 40. To reattach theremovable portion 57, or to attach a newremovable portion 57, the described steps are reversed. - Turning to a further embodiment illustrated in
FIGS. 11 to 13 , thetissue manipulation device 200 may be substantially identical to thetissue manipulation device 10 previously described, with the exception that arigid torque member 202 may replace one or more of the torque links 58. In particular, thetorque member 202 may extend along anaxis 205 from aproximal end 204 to adistal end 206, and theaxis 205 may be aligned with the portion of theshaft axis 47 that extends along thelinear portion 140 of theshaft portion 40. Thetorque member 202 may include acentral bore 208 that extends through thetorque member 202 from theproximal end 204 to thedistal end 206 along theaxis 205. The torque member may have any suitable cross-sectional shape or combination of shapes to allow thetorque member 202 to transmit torque and to fit in thelinear portion 140 of theshaft portion 40. - The
torque member 202 may be a single, unitary part or may be an assembly of two or more components that cooperate to form thetorque member 202. In operation, a portion of thewire 52 may be disposed through, and be longitudinally displaceable within, thecentral bore 208 of thetorque member 202. In some embodiments, a guide sheath (not shown) may surround all or a portion of the portion of thewire 52 that extends through thecentral bore 208 of thetorque member 202. - A plurality of receiving
notches 210 may be disposed about a circumferential surface at theproximal end 204 of thetorque member 202 surrounding thecentral bore 208. When the securingmember 24 is in the engaged position 36 (illustrated inFIG. 13 ), each of the plurality of receivingnotches 210 of thetorque member 202 may engage a corresponding one of the plurality ofgear teeth 182 of thewheel hub 170 such that a rotation of thewheel hub 170 causes a corresponding rotation of thetorque member 202 about theaxis 205. - The
torque member 202 may extend distally such that thedistal end 206 of thetorque member 202 is disposed at or adjacent to theintermediate point 144 of theshaft portion 140, which is at a distal end of the distal end of thelinear portion 140 of theshaft portion 40 and at a proximal end of the of thecurved portion 142 of theshaft portion 40. A plurality ofgear teeth 212 may be disposed about a circumferential surface at thedistal end 204 of thetorque member 202 surrounding thecentral bore 208. The plurality ofgear teeth 212 may be disposed on aremovable end portion 214 that forms thedistal end 206 of thetorque member 202. The plurality ofgear teeth 212 may engage a first of two ormore torque links 58 that may be identical to those previously described, and the two ormore torque links 58 may be disposed in thecurved portion 142 of theshaft portion 140. As such, each of the plurality ofgear teeth 212 at thedistal end 204 of thetorque member 202 may engage a corresponding one of the plurality of receivingnotches 190 a of thefirst torque link 58 a such that a rotation of thetorque member 202 causes a corresponding rotation of thefirst torque link 58 a. The rotation of thefirst torque link 58 a causes a corresponding rotation of thesecond torque line 58 b (and any additional torque links 58) to rotate theend effector 48 relative to thedistal end 44 of theshaft portion 40. - Advantageously, the
torque member 202 efficiently transmits a torque applied to theproximal end 204 of thetorque member 202 to thedistal end 206 of thetorque member 202 without rotational lag, allowing for precise rotational control and more immediate response when a user rotates theadjustment wheel 122. - In some embodiments, the
torque member 202 may not be a portion of theremovable portion 57 that may be removed through thedistal end 44 of theshaft portion 40 as a unit when the securingmember 24 is pivoted from the engaged position 36 (illustrated inFIG. 4A ) to the disengaged position 39 (illustrated inFIG. 5 ). However, in other embodiments, thetorque member 202 may be a portion of theremovable portion 57, and theproximal end 204 of thetorque member 202 may be disposed adjacent to theproximal end 54 of thewire 52 or adjacent to a portion of thecoupling portion 52 a, In such an embodiment, a feature (not shown) coupled to or formed on the wire 52 (orcoupling portion 52 a) may prevent theproximal end 204 of thetorque member 202 from displacing beyond theproximal end 54 of thewire 52 when theremovable portion 57 is removed through thedistal end 44 of theshaft portion 40. - For example,
FIGS. 16 to 18D illustrate an embodiment of aremovable portion 300 that may include an embodiment of atorque member 302. In this embodiment, thetorque member 302 may extend along anaxis 304 from aproximal end 306 to adistal end 308, and theaxis 304 may be aligned with the portion of theshaft axis 47 that extends along thelinear portion 140 of the shaft portion 40 (seeFIG. 10A ). Theaxis 304 may also be parallel to or aligned with (in an unbent or linear configuration) with the X-axis of the reference coordinate system ofFIGS. 16 and 17A . Thetorque member 302 may be configured to transmit torque that is input at theproximal end 306 to theoutput end 308 when thetorque member 302 is rotated about theaxis 304. Thetorque member 302 may also be configured to allow for bending of thetorque member 302 about an axis that is normal to theaxis 304 such that thetorque member 302 may bend only in a first bending plane, thereby allowing thetorque member 302 to efficiently transmit torque without lag or loss from slop, while allowing one or more portions of thetorque member 302 to selectively bend when theremovable portion 300 to be passed through thecurved portion 142 of theshaft portion 40 when inserting or removing theremovable portion 300 for disassembly or reassembly. - Turning to
FIG. 17A , thetorque member 302 may include a base 310 that extends from theproximal end 306 to thedistal end 308. The base 310 may have a constant cross-sectional shape along the length of thetorque member 302. As illustrated inFIG. 17E , the cross-sectional shape of the base 310 (when viewed along the axis 304) may be defined by anupper edge 312 and alower edge 314 that is parallel to and offset from theupper edge 312. Each of theupper edge 312 and alower edge 314 may be parallel to the Y-axis of the reference coordinate system ofFIGS. 16 and 17C . The cross-sectional shape of the base 310 may be further defined by a firstlateral edge 316 and a secondlateral edge 318. The firstlateral edge 316 may extend along or substantially along the Z-axis of the reference coordinate system ofFIGS. 16 and 17C from a first end of theupper edge 312 to a first end of thelower edge 314. The secondlateral edge 318 may extend along or substantially along the Z-axis of the reference coordinate system ofFIGS. 16 and 17C from a second end of theupper edge 312 to a second end of thelower edge 314. Each of the firstlateral edge 316 and the secondlateral edge 318 may be curved to partially curved to form a segment of a circle, for example. - A plurality of
projections 320 may extend from thebase 310, and each of the plurality ofprojections 320 may be spaced along the X-axis of the reference coordinate system ofFIGS. 16 and 17C from an adjacent other of the plurality ofprojections 320. The plurality ofprojections 320 may extend along the entire length of the base 310 from theproximal end 306 to thedistal end 308 of thetorque member 302. In other embodiments, the plurality ofprojections 320 may extend along one or more portions of the length of thebase 310. When viewed in cross-section (along the axis 304), as illustrated inFIG. 17C , each of the plurality ofprojections 320 may be include afirst projection portion 322 a and asecond projection portion 322 b, and thefirst projection portion 322 a and thesecond projection portion 322 b may be symmetrically formed about aplane 325, which is parallel to the X-Z plane of the reference coordinate system ofFIGS. 16 and 17C , and theplane 325 may extend along theaxis 304. Thefirst projection portion 322 a may be defined by anupper projection edge 326 a and alower projection edge 328 a. The lower projection edge 238 a may extend along or generally along the Y-axis of the reference coordinate system ofFIGS. 16 and 17C , and theupper projection edge 326 a may be obliquely disposed (or downwardly sloped) towards thelower projection edge 328 a as theupper projection edge 326 a extends away from theplane 325. Alateral edge 330 a may extend between a first end of theupper projection edge 326 a and a first end of thelower projection edge 328 a, and thelateral edge 330 a may be at least partially curved or rounded. As such, theupper projection edge 326 a, thelower projection edge 328 a, and thelateral edge 330 a may cooperate to generally form shape of a wedge. A secondlateral edge 332 a may extend from a second end of thelower projection edge 328 a to a first portion of theupper edge 312 of thebase 310, and the secondlateral edge 332 a may be least partially curved or rounded. - The
second projection portion 322 b may be a mirror image of thefirst projection portion 322 a and may be symmetrical to thefirst projection portion 322 a about theplane 325. In particular, thesecond projection portion 322 b may be defined by anupper projection edge 326 b and alower projection edge 328 b. The lower projection edge 238 b may extend along or generally along the Y-axis of the reference coordinate system ofFIGS. 16 and 17C , and theupper projection edge 326 b may be obliquely disposed (or downwardly sloped) towards thelower projection edge 328 b as theupper projection edge 326 b extends away from theplane 325. Alateral edge 330 b may extend between a first end of theupper projection edge 326 b and a first end of thelower projection edge 328 b, and thelateral edge 330 b may be curved or rounded. As such, theupper projection edge 326 b, thelower projection edge 328 b, and thelateral edge 330 b may cooperate to generally form shape of a wedge. A secondlateral edge 332 b may extend from a second end of thelower projection edge 328 b to a second portion of theupper edge 312 of thebase 310, and the secondlateral edge 332 a may be least partially curved or rounded. - Each of the plurality of
projections 320 may also include a wire bore 334 from a proximal end of each of the plurality ofprojections 320 to a distal end of each of the plurality ofprojections 320. Each of the wire bores 334 in each of the plurality ofprojections 320 may be aligned or generally aligned with the other plurality ofprojections 320 over the length of theaxis 304 such that, in operation, a corresponding portion of thewire 52 may be disposed through, and be longitudinally displaceable within, the wire bore 334 of each of the plurality ofprojections 320. The wire bore 334 may have any suitable shape to receive the corresponding portion of thewire 52. For example, the wire bore 334 may be a substantiallyU-shaped notch 336 formed between thefirst projection portion 322 a and thesecond projection portion 322 b, and the notch may extend through and along theplane 325. The notch may have a firstlateral portion 338 a that extends downwardly from a second end of theupper projection edge 326 a of thefirst projection portion 322 a and a secondlateral portion 338 b that extends downwardly from a second end of theupper projection edge 326 b of thesecond projection portion 322 b. A notch end edge 340 may extend (e.g., extend parallel to or generally parallel to the Y-axis of the reference coordinate system ofFIGS. 16 and 17C ) between an end of the firstlateral portion 338 a and an end of the secondlateral portion 338 b. - With reference to
FIG. 17A , each of the plurality ofprojections 320 may be spaced along the X-axis of the reference coordinate system ofFIGS. 16 and 17C from an adjacent other of the plurality ofprojections 320. For example, a first 320 a of the plurality orprojections 320 may have a distallateral edge 342 a that may be disposed a first distance D1 along the X-axis from a proximallateral edge 344 b of a second 320 b of the plurality orprojections 320. The second 320 a of the plurality orprojections 320 may have a distallateral edge 342 b that may be disposed a second distance D2 along the X-axis from a proximallateral edge 344 c of a third 320 c of the plurality orprojections 320. In some embodiments, the first distance D1 may be equal to the second distance D2. In some embodiments, the distance along the X-axis between a distal lateral edge 342 x of any of the plurality ofprojections 320 from a proximal lateral edge 344 x of an adjacent one of the plurality orprojections 320 may be the first distance D1. - As illustrated in
FIG. 17A , when viewed along the Y-axis of the reference coordinate system, afirst neck edge 346 and a second neck edge 348 extends obliquely towards the base 310 to form a narrowed neck portion 350 that upwardly extends from thebase 310. The spacing between the first and second adjacent plurality ofprojections 320, as well as the combination of cross-sectional shapes of each of the plurality ofprojections 320, allow thetorque member 302 to bend along an axis that is parallel to the Y-axis of the reference coordinate system ofFIGS. 16 and 17A , that this axis may be normal to theplane 325. Thus, any portion of thetorque member 302 may bend clockwise or counterclockwise about the axis when viewed along the Y-axis, as shown inFIG. 17A . Thus, rotation is allowed in a single bending plane (plane 325), but not along any other planes or along any axis that is not parallel to the Y-axis of the reference coordinate system ofFIGS. 16 and 17A . This ensure sufficient rigidity of thetorque member 302 when thetorque member 302 is rotated about the X-axis of the reference coordinate system ofFIGS. 16 and 17A while allowing thetorque member 302 to bend within a single plane to allow for insertion or extraction of theremovable portion 300 through thecurved portion 142 of theshaft portion 40. - As illustrated in
FIGS. 18A to 18D , thetorque member 302 may also include one or more alignment features 352 that ensures that theremovable portion 300 is oriented correctly when inserted into thedistal end 44 of theshaft portion 40 during the assembly (or reassembly) of thetissue manipulating device 10. The one or more alignment features 352 may include aprotrusion 356 formed at or adjacent to thedistal end 354 of thelinear portion 140 of theshaft portion 40 or at or adjacent to the proximal end of thecurved portion 142 of theshaft portion 40. Theprotrusion 356 may be formed as a depression (e.g., a dome-shaped depression) in theshaft portion 40 and the depression may extend into the shaftinterior portion 146. In some embodiments, the depression may be a dome-shaped depression that may be symmetrically formed or disposed about a plane that extends through theshaft axis 47 and is parallel to the X-Z of the reference coordinate system ofFIGS. 1 and 18D , and the depression may be formed on an upper surface of theshaft portion 40, wherein the direction “upper” corresponds to the direction along the Z-axis in which thecurved portion 142 of theshaft portion 40 extends. - The
alignment feature 352, such as the depression, may be positioned to not contact a portion of the upper projection edges 326 a, 326 b of thefirst projection portion 322 a or thesecond projection portion 322 b of thetorque member 302 when theremovable portion 300 is positioned correctly for insertion. However, when theremovable portion 300 is positioned incorrectly upon insertion into theshaft portion 40, thealignment feature 352 may contact a portion of the sloped upper projection edges 326 a, 326 b of thefirst projection portion 322 a or thesecond projection portion 322 b to rotate thetorque member 302, and the entireremovable portion 300, into correct alignment to allow for the curving of thetorque member 302 upon insertion into theshaft portion 40.FIG. 18C illustrates various orientations of thetorque member 302 relative to thealignment feature 352 within theshaft portion 40. -
FIGS. 19A to 19K illustrate a further embodiment of a removable portion 400 that may include an embodiment of atorque member 402 that may be similar to, but have a slightly different cross-sectional shape from, thetorque member 302 illustrated inFIGS. 16 to 18D . As illustrated inFIG. 19K , thetorque member 402 may extend along anaxis 404 from aproximal end 406 to adistal end 408, and thetorque member 402 may include a base 410 that extends from theproximal end 406 to thedistal end 408. The base 410 may have a constant cross-sectional shape along the length of thetorque member 402. As illustrated inFIG. 19J , the cross-sectional shape of the base 410 (when viewed along the axis 404) may be defined by anupper edge 412 and alower edge 314 that is parallel to and offset from theupper edge 412. Each of theupper edge 412 and alower edge 414 may be parallel to the Y-axis of the reference coordinate system ofFIG. 19J . The cross-sectional shape of the base 410 may be further defined by a firstlateral edge 416 and a secondlateral edge 418. The firstlateral edge 416 may extend along or substantially along the Z-axis of the reference coordinate system ofFIG. 19J from a first end of theupper edge 412 to a first end of thelower edge 414. The secondlateral edge 418 may extend along or substantially along the Z-axis of the reference coordinate system ofFIG. 19J from a second end of theupper edge 412 to a second end of thelower edge 414. Each of the firstlateral edge 416 and the secondlateral edge 418 may be curved, contoured, or partially curved. - A plurality of
projections 420 may extend from thebase 410, and each of the plurality ofprojections 420 may be spaced along the X-axis of the reference coordinate system ofFIG. 19D from an adjacent other of the plurality ofprojections 420. The plurality ofprojections 420 may extend along the entire length of the base 410 or may extend along one or more portions of the length of thebase 410. When viewed in cross-section (along the axis 404), as illustrated inFIG. 19C , each of the plurality ofprojections 420 may be include afirst projection portion 422 a and asecond projection portion 422 b, and thefirst projection portion 422 a and thesecond projection portion 422 b may be symmetrically formed about a plane 425, which is parallel to the X-Z plane of the reference coordinate system ofFIGS. 19C and 19D , and the plane 425 may extend along theaxis 404. Thefirst projection portion 422 a may be defined by anupper projection edge 426 a which may extend along or generally along the Y-axis of the reference coordinate system ofFIG. 19C , and alateral edge 430 a may extend between a first end of theupper projection edge 326 a and a first end of the base 410 (e.g., a first end of theupper edge 412 of the base 410), and thelateral edge 430 a may be at least partially curved or rounded. Thesecond projection portion 422 b may be a mirror image of thefirst projection portion 422 a and may be symmetrical to thefirst projection portion 422 a about the plane 425. In particular, thesecond projection portion 422 b may be defined by anupper projection edge 426 b which may extend along or generally along the Y-axis of the reference coordinate system ofFIG. 19C , and alateral edge 430 b may extend between a first end of theupper projection edge 426 b and a second end of the base 410 (e.g., a second end of theupper edge 412 of the base 410), and thelateral edge 430 b may be at least partially curved or rounded. - Each of the plurality of
projections 420 may also include awire bore 434 that from a proximal end of each of the plurality ofprojections 420 to a distal end of each of the plurality ofprojections 420. Each of the wire bores 434 in each of the plurality ofprojections 420 may be aligned or generally aligned with the other plurality ofprojections 420 over the length of theaxis 404 such that, in operation, a corresponding portion of thewire 52 may be disposed through, and be longitudinally displaceable within, the wire bore 434 of each of the plurality ofprojections 420. The wire bore 434 may have any suitable shape to receive the corresponding portion of thewire 52. For example, the wire bore 434 may be a substantiallyU-shaped notch 436 formed between thefirst projection portion 422 a and thesecond projection portion 422 b, and thenotch 436 may extend through and along the plane 425. Thenotch 436 may have a firstlateral portion 438 a that extends downwardly from a second end of theupper projection edge 426 a of thefirst projection portion 422 a and a secondlateral portion 438 b that extends downwardly from a second end of theupper projection edge 426 b of thesecond projection portion 422 b. Anotch bottom edge 440 may extend between an end of the firstlateral portion 438 a and an end of the secondlateral portion 438 b, and the notchbottom edge 440 may have the shape of a segment of a circle. - With reference to
FIG. 19D , each of the plurality ofprojections 420 may be spaced along the X-axis of the reference coordinate system ofFIGS. 19D and 19K from an adjacent other of the plurality ofprojections 420. For example, a first 420 a of the plurality orprojections 420 may have a distallateral edge 442 a that may be disposed a first distance D1 along the X-axis from a proximallateral edge 444 b of a second 420 b of the plurality orprojections 420. The second 420 a of the plurality orprojections 420 may have a distallateral edge 442 b that may be disposed a second distance D2 along the X-axis from a proximal lateral edge 444 c of a third 420 c of the plurality orprojections 420. In some embodiments, the first distance D1 may be equal to the second distance D2. In some embodiments, the distance along the X-axis between a distal lateral edge 442 x of any of the plurality ofprojections 420 from a proximal lateral edge 444 x of an adjacent one of the plurality orprojections 420 may be the first distance D1. - As illustrated in
FIG. 19D , when viewed along the Y-axis of the reference coordinate system, afirst neck edge 446 and asecond neck edge 448 extends obliquely towards the base 410 to form a narrowedneck portion 450 that extends upward from thebase 410. The spacing between the first and second adjacent plurality ofprojections 420, as well as the combination of cross-sectional shapes of each of the plurality ofprojections 420, allow thetorque member 402 to bend along an axis that is parallel to the Y-axis of the reference coordinate system ofFIGS. 19C and 19D , that this axis may be normal to the plane 425. Thus, any portion of thetorque member 402 may bend clockwise or counterclockwise about the axis when viewed along the Y-axis, as shown inFIG. 19D . Thus, rotation is allowed in a single bending plane (plane 425), but not along any other planes or along any axis that is not parallel to the Y-axis of the reference coordinate system ofFIG. 19D . This ensures sufficient rigidity of thetorque member 402 when thetorque member 402 is rotated about the X-axis of the reference coordinate system ofFIGS. 19D and 19K while allowing thetorque member 402 to bend within a single plane to allow for insertion or extraction of the removable portion 400 through thecurved portion 142 of theshaft portion 40. -
FIGS. 20A to 20F illustrate a further embodiment of aremovable portion 500 that may include an embodiment of atorque member 502 that may be similar to, but have a different cross-sectional shape from, thetorque member 302 illustrated inFIGS. 16 to 18D and thetorque member 402 illustrated inFIGS. 19A to 19K . As illustrated inFIG. 19A , thetorque member 502 may extends along anaxis 504 from aproximal end 506 to adistal end 508, and thetorque member 502 may include a base 510 that extends from theproximal end 506 to thedistal end 508, and the base 510 may be similar to thebase 410 ofbase 310 previously described. - A plurality of
projections 520 may extend from thebase 510, and each of the plurality ofprojections 520 may be spaced along the X-axis of the reference coordinate system ofFIG. 20A from an adjacent other of the plurality ofprojections 420, in a manner similar or identical to the plurality ofprojections 420 or the plurality ofprojections 320 previously described. Each of the plurality of projections may have a rectangular of square (or substantially rectangular or square) cross-sectional shape, as illustrated inFIG. 20F . Each of the plurality ofprojections 520 may also include awire bore 534 that extends from a proximal end of each of the plurality ofprojections 520 to a distal end of each of the plurality ofprojections 520. Each of the wire bores 534 in each of the plurality ofprojections 520 may be aligned or generally aligned with the other plurality ofprojections 520 over the length of theaxis 504 such that, in operation, a corresponding portion of thewire 52 may be disposed through, and be longitudinally displaceable within, the wire bore 534 of each of the plurality ofprojections 520. The wire bore 534 may have any suitable shape to receive the corresponding portion of thewire 52. For example, the wire bore 534 may be cylindrical and may have an axis that extends parallel to the X-axis of the reference coordinate system ofFIG. 20C . In cross-section, the wire bore 534 may have a circular edge 540 that may be symmetrically disposed about aplane 525 that is parallel to the X-Z plane of the reference coordinate system ofFIG. 20A , and theplane 525 may extend along theaxis 504. - With reference to
FIG. 20C , each of the plurality ofprojections 520 may be spaced along the X-axis of the reference coordinate system ofFIG. 20C from an adjacent other of the plurality ofprojections 520 in a manner identical to that of the plurality ofprojections 420 or the plurality ofprojections 320 previously described. The spacing between the first and second adjacent plurality ofprojections 520, as well as the combination of cross-sectional shapes of each of the plurality ofprojections 520, allow thetorque member 502 to bend along an axis that is parallel to the Y-axis of the reference coordinate system ofFIG. 20A , that this axis may be normal to theplane 525. Thus, any portion of thetorque member 502 may bend clockwise or counterclockwise about the axis when viewed along the Y-axis, as shown inFIG. 20C . Thus, rotation is allowed in a single bending plane (plane 525), but not along any other planes or along any axis that is not parallel to the Y-axis of the reference coordinate system ofFIG. 20A . As previously explained, this ensures sufficient rigidity of thetorque member 502 when thetorque member 502 is rotated about the X-axis of the reference coordinate system ofFIG. 20A while allowing thetorque member 502 to bend within a single plane to allow for insertion or extraction of theremovable portion 500 through thecurved portion 142 of theshaft portion 40. - The
torque member 202 may be comprised of any suitable material or combination of materials, such as plastic or stainless steel. - Turning now to the embodiment illustrated in
FIGS. 21A to 24B , atissue engaging assembly 600 may be used instead of thetissue engaging members 20 of theend effector 48 illustrated inFIGS. 8, 11, and 12 . In particular, thetissue engaging assembly 600 may be used in an embodiment of anend effector assembly 602 illustrated inFIGS. 25 to 26C , and the embodiment of theend effector assembly 602 will be described in more detail below. The embodiment of theend effector assembly 602 may be used in the embodiment of thetissue manipulation device 10 previously described or in any other embodiment of a tissue manipulation device, and theend effector assembly 602 may rotate or otherwise displace relative to thedistal end 44 of theshaft portion 40 as previously described. - The
tissue engaging assembly 600 may be a single, unitary part that may allow for two or moretissue engaging arms 604 that may be deployable to secure and/or displace a patient's prostate during a procedure. This single part may be manufactured or produced in any suitable manner, such as by injection molding the part using a plastic material. Similar to theend effector 48, theend effector assembly 602 may be displaced from a first undeployed position 603 (illustrated inFIG. 25 ) to a second deployed position 605 (illustrated inFIGS. 26A to 26C ). For example, theend effector assembly 602 may be in the firstundeployed position 603 to be inserted into the urethra of a patient, then theend effector assembly 602 may be transitioned to the second deployedposition 605 when positioned within a portion of the patent's prostate, allowing the surgeon to physically manipulate or position the prostate as desired. When it is desired to remove theend effector assembly 602, theend effector assembly 602 may be transitioned back to the firstundeployed position 603 and removed from the urethra. - Turning to 21A to 24B, the
tissue engaging assembly 600 may include two, three, four, or moretissue engaging arms 604. For example, thetissue engaging assembly 600 may include fourtissue engaging arms 604, which includes a firsttissue engaging arm 604 a, a secondtissue engaging arm 604 b, a thirdtissue engaging arm 604 c, and a fourthtissue engaging arm 604 d.FIGS. 21A to 22C illustrates the pre-assembled configuration of thetissue engaging assembly 600, such as the configuration of thetissue engaging assembly 600 after injection molding and before assembly or integration into theend effector assembly 602 as illustrated inFIGS. 25 to 27 . With reference toFIG. 22A , the firsttissue engaging arm 604 a may be elongated and may extend from afirst end 606 a to asecond end 608 a along afirst arm axis 610 a that may be parallel to (or aligned with) the X-axis of the reference coordinate system ofFIG. 22A , and thefirst end 606 a may be coupled to afirst portion 611 a of ahub portion 611. The firsttissue engaging arm 604 a may include two or more arm segments, and in some embodiments, the firsttissue engaging arm 604 a may include afirst arm segment 612 a, asecond arm segment 614 a, and athird arm segment 616 a. - Referring to
FIG. 24A , thefirst arm segment 612 a of the firsttissue engaging arm 604 a may extend from afirst end 618 a to asecond end 620 a along thefirst arm axis 610 a. Thefirst end 618 a of thefirst arm segment 612 a may be adjacent to (or may correspond to) thefirst end 606 a of the firsttissue engaging arm 604 a, and thefirst end 618 a may be coupled to (and be adjacent to and offset from) thefirst portion 611 a of thehub portion 611. Thefirst end 618 a of thefirst arm segment 612 a may be coupled to thefirst portion 611 a of thehub portion 611 in any suitable manner, such as with afirst hinge 622 a. Thefirst hinge 622 a may be a living hinge that may extend between thefirst end 618 a of thefirst arm segment 612 a and thefirst portion 611 a of thehub portion 611. - The
first arm segment 612 a may have any cross-sectional shape or combination of shapes (when viewed along thefirst arm axis 610 a) from thefirst end 618 a to thesecond end 620 a. For example, as illustrated inFIG. 24B , thefirst arm segment 612 a may have a constant or substantially constant cross-sectional shape (when viewed along thefirst arm axis 610 a) from thefirst end 618 a to thesecond end 620 a, and the cross-sectional shape offirst arm segment 612 a may have a polygonal shape. The cross-sectional shape of thefirst arm segment 612 a may be partially defined by a pair of opposedlateral edges FIGS. 22A and 24B . The cross-sectional shape of thefirst arm segment 612 a may also be partially defined by a pair of innerlateral edges lateral edges lateral edges - The
second arm segment 614 a of the firsttissue engaging arm 604 a may extend from afirst end 625 a to asecond end 626 a along thefirst arm axis 610 a, and thefirst end 625 a may be adjacent to (and offset from) thesecond end 620 a of thefirst arm segment 612 a. Thefirst end 625 a of thesecond arm segment 614 a may be coupled to thesecond end 620 a of thefirst arm segment 612 a in any suitable manner, such as with asecond hinge 627 a. Thesecond hinge 627 a may be a living hinge that may extend between thefirst end 625 a of thesecond arm segment 614 a and thesecond end 620 a of thefirst arm segment 612 a. The cross-sectional shape of thesecond arm segment 614 a may be identical or substantially identical to the cross-sectional shape of thefirst arm segment 612 a. - The
third arm segment 616 a may extend from afirst end 628 a to asecond end 629 a along thefirst arm axis 610 a, and thefirst end 628 a may be adjacent to (and offset from) thesecond end 626 a of thesecond arm segment 614 a. Thefirst end 628 a of thethird arm segment 616 a may be coupled to asecond end 626 a of thesecond arm segment 614 a in any suitable manner, such as with athird hinge 630 a. Thethird hinge 630 a may be a living hinge that may extend between thefirst end 628 a of thethird arm segment 616 a and thesecond end 626 a of thesecond arm segment 614 a. Thesecond end 629 a of thethird arm segment 616 a may be coupled to a portion of the firstend cap segment 632 a in any suitable manner, such as with afourth hinge 633 a. Thefourth hinge 633 a may be a living hinge that may extend between thesecond end 629 a of thethird arm segment 616 a and the portion of the firstend cap segment 632 a. The cross-sectional shape of thesecond arm segment 614 a may be identical or substantially identical to the cross-sectional shape of thefirst arm segment 612 a and/or thesecond arm segment 614 a. - When the
end effector assembly 602 is displaced from the first undeployed position 603 (illustrated inFIG. 25 ) to the second deployed position 605 (illustrated inFIGS. 26A to 26C ) in a manner that will be described in more detail below, afirst mating feature 632 a of thefirst arm segment 612 a (or one or more portions of thefirst mating feature 632 a of thefirst arm segment 612 a) may engage a correspondingfirst mating feature 634 a of thesecond arm segment 614 a (or a corresponding one or more portions of thefirst mating feature 634 a of thesecond arm segment 614 a) to maintain thefirst arm segment 612 a and thesecond arm segment 614 a in a desired position when theend effector assembly 602 is in the second deployedposition 605. For example, as illustrated inFIG. 23 , thefirst mating feature 632 a of thefirst arm segment 612 a may include afirst notch 636 a that may be configured to receive a first protrusion 638 a of thefirst mating feature 634 a of thesecond arm segment 614 a. Aforward contact surface 640 a may define a portion of the first protrusion 638 a, and theforward contact surface 640 a may be configured to contact anoblique contact surface 642 a that defines a portion of thefirst notch 636 a when theend effector assembly 602 is displaced to the second deployedposition 605. - The
forward contact surface 640 a of the first protrusion 638 a may be planar and may be normal or substantially normal to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. Theoblique contact surface 642 a of thefirst notch 636 a may be planar and may be disposed at an oblique angle relative to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. Accordingly, when theend effector assembly 602 is displaced to the second deployedposition 605 such that thefirst arm segment 612 a bends, rotates, or pivots relative to thesecond arm segment 614 a (and/or vice versa) about thesecond hinge 627 a, the planar surface of theforward contact surface 640 a of the first protrusion 638 a comes into contact with the planaroblique contact surface 642 a of thefirst notch 636 a to prevent further bending of thefirst arm segment 612 a and thesecond arm segment 614 a about thesecond hinge 627 a. - The
first mating feature 632 a of thefirst arm segment 612 a may also include a pair of end surfaces 644 a that may also partially define thefirst notch 636 a and thesecond end 620 a of thefirst arm segment 612 a. Further, thefirst mating feature 634 a of thesecond arm segment 614 a may include a pair of lateral oblique contact surfaces 646 a that may also partially define the first protrusion 638 a and extend from thefirst end 625 a (and towards thesecond end 626 a) of thesecond arm segment 614 a. In some embodiments, the pair of lateral oblique contact surfaces 646 a may be symmetrically disposed about the first protrusion 638 a such that a first of the pair of lateral oblique contact surfaces 646 a may be on a first lateral side of the first protrusion 638 a and a second of the pair of lateral oblique contact surfaces 646 a may be on a second lateral side of the first protrusion 638 a. - The pair of end surfaces 644 a of the
first mating feature 632 a of thefirst arm segment 612 a may be planar and may be normal or substantially normal to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. The lateraloblique contact surface 646 a of thefirst mating feature 634 a of thesecond arm segment 614 a may be planar and may be disposed at an oblique angle relative to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. Accordingly, when theend effector assembly 602 is displaced to the second deployedposition 605 such that thefirst arm segment 612 a bends, rotates, or pivots relative to thesecond arm segment 614 a (and/or vice versa) about thesecond hinge 627 a, the planar pair of end surfaces 644 a comes into contact with the planar lateral oblique contact surfaces 646 a to prevent further bending of thefirst arm segment 612 a and thesecond arm segment 614 a about thesecond hinge 627 a. In some embodiments, the planar pair of end surfaces 644 a comes into contact with the planar lateral oblique contact surfaces 646 a at the same position as theforward contact surface 640 a of the first protrusion 638 a comes into contact with the planaroblique contact surface 642 a of thefirst notch 636 a to provide maximum resistance against further bending of thefirst arm segment 612 a and thesecond arm segment 614 a about thesecond hinge 627 a when theend effector assembly 602 is displaced into the second deployedposition 605. - In addition, when the
end effector assembly 602 is displaced from the first undeployed position 603 (illustrated inFIG. 25 ) to the second deployed position 605 (illustrated inFIGS. 26A to 26C ), asecond mating feature 648 a of thesecond arm segment 614 a (or one or more portions of thesecond mating feature 648 a of thesecond arm segment 614 a) may engage a correspondingfirst mating feature 650 a of thethird arm segment 616 a (or a corresponding one or more portions of thefirst mating feature 650 a of thethird arm segment 616 a) to maintain thethird arm segment 616 a and thesecond arm segment 614 a in a desired position when theend effector assembly 602 is in the second deployedposition 605. For example, as illustrated inFIG. 23 , thefirst mating feature 650 a of thethird arm segment 616 a may include afirst notch 652 a that may be configured to receive asecond protrusion 654 a of thesecond mating feature 648 a of thesecond arm segment 614 a. Aforward contact surface 656 a may define a portion of thesecond protrusion 654 a, and theforward contact surface 656 a may be configured to contact anoblique contact surface 658 a that defines a portion of thefirst notch 652 a of thefirst mating feature 650 a of thethird arm segment 616 a when theend effector assembly 602 is displaced to the second deployedposition 605. - The
forward contact surface 656 a of thesecond protrusion 654 a may be planar and may be normal or substantially normal to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. Theoblique contact surface 658 a of thefirst notch 652 a of thefirst mating feature 650 a of thethird arm segment 616 a may be planar and may be disposed at an oblique angle relative to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. Accordingly, when theend effector assembly 602 is displaced to the second deployedposition 605 such that thethird arm segment 616 a bends, rotates, or pivots relative to thesecond arm segment 614 a (and/or vice versa) about thethird hinge 630 a, the planar surface of theforward contact surface 656 a of thesecond protrusion 654 a comes into contact with theoblique contact surface 658 a of thefirst notch 652 a of thefirst mating feature 650 a of thethird arm segment 616 a to prevent further bending of thethird arm segment 616 a and thesecond arm segment 614 a about thethird hinge 630 a. - The
first mating feature 650 a of thethird arm segment 616 a may also include a pair of end surfaces 660 a that may also partially define thefirst notch 652 a and thefirst end 628 a of thethird arm segment 616 a. Further, thesecond mating feature 648 a of thesecond arm segment 614 a may include a pair of lateral oblique contact surfaces 662 a that may also partially define thesecond protrusion 654 a and extend from thesecond end 626 a (and towards thefirst end 625 a) of thesecond arm segment 614 a. In some embodiments, the pair of lateral oblique contact surfaces 662 a may be symmetrically disposed about thesecond protrusion 654 a such that a first of the pair of lateral oblique contact surfaces 662 a may be on a first lateral side of thesecond protrusion 654 a and a second of the pair of lateral oblique contact surfaces 662 a may be on a second lateral side of thesecond protrusion 654 a. - The pair of end surfaces 660 a of the
first mating feature 650 a of thethird arm segment 616 a may be planar and may be normal or substantially normal to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. The lateraloblique contact surface 662 a of thesecond mating feature 648 a of thesecond arm segment 614 a may be planar and may be disposed at an oblique angle relative to thefirst arm axis 610 a when theend effector assembly 602 is in the firstundeployed position 603. Accordingly, when theend effector assembly 602 is displaced to the second deployedposition 605 such that thethird arm segment 616 a bends, rotates, or pivots relative to thesecond arm segment 614 a (and/or vice versa) about thethird hinge 630 a, the planar pair of end surfaces 660 a comes into contact with the planar lateral oblique contact surfaces 662 a to prevent further bending of thethird arm segment 616 a and thesecond arm segment 614 a about thethird hinge 630 a. In some embodiments, the planar pair of end surfaces 660 a comes into contact with the planar lateral oblique contact surfaces 662 a at the same position as theforward contact surface 656 a of thesecond protrusion 654 a comes into contact with the planaroblique contact surface 658 a of thefirst notch 652 a to provide maximum resistance against further bending of thethird arm segment 616 a and thesecond arm segment 614 a about thethird hinge 630 a when theend effector assembly 602 is displaced into the second deployedposition 605. - Referring to
FIGS. 21A to 22A , thetissue engaging assembly 600 may include the secondtissue engaging arm 604 b that may be identical to the firsttissue engaging arm 604 a, and the secondtissue engaging arm 604 b may be arranged symmetrical to (i.e., a may be a mirror image of) the firsttissue engaging arm 604 a about a plane that extends through a third arm axis 210 c and is parallel to the Y-Z plane of the reference coordinate system ofFIGS. 21B and 22A . Accordingly, features of the secondtissue engaging arm 604 b that correspond to features of the firsttissue engaging arm 604 a are indicated by reference numbers of the firsttissue engaging arm 604 a, but are designated using a “b” suffix instead of the “a” suffix used with the firsttissue engaging arm 604 a. - In particular, and as illustrated in
FIG. 22A , the secondtissue engaging arm 604 b may be elongated and may extend from afirst end 606 b to asecond end 608 a along asecond arm axis 610 b that may be parallel to (or aligned with) the X-axis of the reference coordinate system ofFIG. 22A , and thesecond arm axis 610 b may be aligned with thefirst arm axis 610 a. Thefirst end 606 a may be coupled to a second portion 211 b of thehub portion 611. The secondtissue engaging arm 604 b may include two or more arm segments, and the secondtissue engaging arm 604 b may include afirst arm segment 612 b, asecond arm segment 614 b, and athird arm segment 616 b. - Referring to
FIG. 22A , afirst end 618 b of thefirst arm segment 612 b may be coupled to thesecond portion 611 b of thehub portion 611 with afirst hinge 622 b, which may be a living hinge. Afirst end 625 b of thesecond arm segment 614 b may be coupled to asecond end 620 b of thefirst arm segment 612 b with asecond hinge 627 b, which may be a living hinge. Afirst end 628 b of thethird arm segment 616 b may be coupled to asecond end 626 b of thesecond arm segment 614 b with a third hinge 630 b, which may be a living hinge. Asecond end 629 b of thethird arm segment 616 b may be coupled to a portion of a secondend cap segment 632 b with afourth hinge 633 b, which may be a living hinge. The cross-sectional shape of each of thefirst arm segment 612 b, thesecond arm segment 614 b, and thethird arm segment 616 b of the secondtissue engaging arm 604 b may correspond to the cross-sectional shape of each of thefirst arm segment 612 a, thesecond arm segment 614 a, and thethird arm segment 616 a of the firsttissue engaging arm 604 a, respectively. - Referring to
FIGS. 21A to 22A , thetissue engaging assembly 600 may include the thirdtissue engaging arm 604 c and the fourthtissue engaging arm 604 d, which may be identical to the firsttissue engaging arm 604 a and the secondtissue engaging arm 604 b, respectively. Accordingly, features of the thirdtissue engaging arm 604 c that correspond to features of the firsttissue engaging arm 604 a are indicated by reference numbers of the firsttissue engaging arm 604 a, but are designated using a “c” suffix instead of the “a” suffix used with the firsttissue engaging arm 604 a. Further, features of the fourthtissue engaging arm 604 d that correspond to features of the firsttissue engaging arm 604 a are indicated by reference numbers of the firsttissue engaging arm 604 a, but are designated using a “d” suffix instead of the “a” suffix used with the firsttissue engaging arm 604 a. - The third
tissue engaging arm 604 c and the fourthtissue engaging arm 604 d may be arranged at an angle relative to the firsttissue engaging arm 604 a and the secondtissue engaging arm 604 b. For example, the thirdtissue engaging arm 604 c may be elongated and may extend from afirst end 606 c to asecond end 608 c along athird arm axis 610 c, and the fourthtissue engaging arm 604 d may be elongated and may extend from a first end 606 d to asecond end 608 d along afourth arm axis 610 d that may be aligned with thethird arm axis 610 c. Thethird arm axis 610 c (and thefourth arm axis 610 d) may be arranged at an angle (e.g., a right angle) with thefirst arm axis 610 a (and thesecond arm axis 610 b) such that thethird arm axis 610 c and thefourth arm axis 610 d are each parallel to (or aligned with) the Y-axis of the reference coordinate system ofFIG. 22A , as illustrated inFIG. 22A . - In particular, and as illustrated in
FIG. 22A , the thirdtissue engaging arm 604 c may be elongated and may extend from afirst end 606 c to asecond end 608 c along thethird arm axis 610 c. Thefirst end 606 c may be coupled to athird portion 611 c of thehub portion 611. The thirdtissue engaging arm 604 c may include two or more arm segments, and the thirdtissue engaging arm 604 c may include afirst arm segment 612 c, asecond arm segment 614 c, and athird arm segment 616 c. Each of thefirst arm segment 612 c, thesecond arm segment 614 c, and thethird arm segment 616 c may be identical (or substantially identical) to thefirst arm segment 612 a, thesecond arm segment 614 a, and thethird arm segment 616 a, respectively, of the firsttissue engaging arm 604 a that was previously described. Asecond end 629 c of thethird arm segment 616 c may be coupled to a portion of a thirdend cap segment 632 c, as previously described. - Further, as illustrated in
FIG. 22A , the fourthtissue engaging arm 604 d may be elongated and may extend from a first end 606 d to asecond end 608 d along thefourth arm axis 610 d. The first end 606 d may be coupled to a fourth portion 211 d of thehub portion 611. The fourthtissue engaging arm 604 d may include two or more arm segments, and the fourthtissue engaging arm 604 d may include afirst arm segment 612 d, asecond arm segment 614 d, and athird arm segment 616 d. Each of thefirst arm segment 612 d, thesecond arm segment 614 d, and thethird arm segment 616 d may be identical (or substantially identical) to thefirst arm segment 612 b, thesecond arm segment 614 b, and thethird arm segment 616 b, respectively, of the secondtissue engaging arm 604 b that was previously described. Asecond end 629 d of thethird arm segment 616 d may be coupled to a portion of a fourthend cap segment 632 d, as previously described. - As illustrated in
FIG. 25 , theend effector assembly 602 may include ahousing 664, and thetissue engaging assembly 600 may be disposed within (or at least partially within) and/or may be coupled to a portion of thehousing 664. Thehousing 664 may be similar to thehousing 150 of the embodiment of theend effector 48 previously described (with reference toFIGS. 6, 8, and 10A , for example), and thehousing 664 may extend from aproximal end 667 to adistal end 668 along anend effector axis 665. Similar to the twowindows FIGS. 6 and 7 ), thehousing 664 of the current embodiment of theend effector assembly 602 may have two or more windows 666. In particular, thehousing 664 may have four windows (e.g., afirst window 666 a, a second window 666 b, a third window 666 c, and afourth window 666 d, and each window 666 may be associated (and operatively aligned) with a corresponding one of the firsttissue engaging arm 604 a, the secondtissue engaging arm 604 b, the thirdtissue engaging arm 604 b, and the fourthtissue engaging arm 604 d, respectively. Each of thefirst window 666 a, the second window 666 b, the third window 666 c, and thefourth window 666 d may be arrayed in any configuration on thehousing 664. For example, each of thefirst window 666 a, the second window 666 b, the third window 666 c, and thefourth window 666 d may be disposed at even intervals about theeffector axis 665, such as 90 degree intervals, as illustrated inFIG. 26B . Any or all of thefirst window 666 a, the second window 666 b, the third window 666 c, and thefourth window 666 d may be elongated and may extend from a proximal end to a distal end along an axis that is parallel to or substantially parallel to theend effector axis 665. One or more interior surfaces of thehousing 664 may define or partially define a housing interior 676 (illustrated inFIG. 26A ), and each of the two or more windows 666 may extend from an exterior surface defining thehousing 664 towards theend effector axis 665 such that each of the two or more windows 666 opens to thehousing interior 676. - In some embodiments, the
hub portion 611 of thetissue engaging assembly 600 may be disposed in (or within) thehousing interior 676 of thehousing 664 at or adjacent to thedistal end 668, and thehub portion 611 may be coupled (or fixedly coupled) to the portion of thehousing 664 such that thehub portion 611 remains stationary relative to thehousing 664 when theend effector assembly 602 is displaced from the first undeployed position 603 (illustrated inFIG. 25 ) to the second deployed position 605 (illustrated inFIGS. 26A to 26C ) and vice versa. In some embodiments, thehub portion 611 may be coupled to a portion of anend cap 670 coupled to thedistal end 668 of thehousing 664, as best illustrated inFIG. 27 showing theend effector assembly 602 with thehousing 664 omitted for clarity. - As illustrated in
FIG. 26A , theend effector assembly 602 may also include aplunger 669 that may be similar or identical to theplunger 30 of theend effector 48 previously described, and theplunger 669 may be directly or indirectly coupled to one of more of the torque links 58 (seeFIG. 7 ) and/or to the torque member 202 (seeFIG. 11 ) that were previously described. Theplunger 669 may be disposed at least partially in the housing 664 (i.e., within the housing interior 676) at or adjacent to thedistal end 668, and theplunger 669 may be longitudinally displaceable relative to the housing 664 (i.e., displaceable along the end effector axis 665) in the same manner as theplunger 30 previously described. All or a portion of each of the firstend cap segment 632 a of the firsttissue engaging arm 604 a, the secondend cap segment 632 b of the secondtissue engaging arm 604 b, the thirdend cap segment 632 c of the thirdtissue engaging arm 604 c, and the fourthend cap segment 632 d of the fourthtissue engaging arm 604 b may be secured to (or within, or partially within) a portion of theplunger 669 to couple theplunger 669 to thetissue engaging assembly 600. In some embodiments, each of the firstend cap segment 632 a of the firsttissue engaging arm 604 a, the secondend cap segment 632 b of the secondtissue engaging arm 604 b, the thirdend cap segment 632 c of the thirdtissue engaging arm 604 c, and the fourthend cap segment 632 d of the fourthtissue engaging arm 604 b may form a pie-shaped wedge (illustrated inFIG. 21B ) that cooperate to form a disk-shape when assembled, and this disk-shape may be received into a complementary recess formed in theplunger 669. As such when theplunger 669 is at a first position, such as a first proximal position (illustrated forplunger 30 inFIG. 6 ), theend effector assembly 602 is in the firstundeployed position 603 illustrated inFIG. 25 . In such a position, each of thefirst arm axis 610 a, thesecond arm axis 610 b,third arm axis 610 c, andfourth arm axis 610 a are parallel or substantially parallel to theend effector axis 665, and all or a portion of each of thefirst arm segment 612 a, thesecond arm segment 614 a, and thethird arm segment 616 a may be disposed within theinterior portion 676 of the housing 664 (or within an aperture in thehousing 664 forming thefirst window 666 a). - When the
plunger 669 displaces distally (in the manner previously described in relation to plunger 30) along theend effector axis 665 from this first proximal position to a second position, such as a second distal position (illustrated inFIG. 27 showing theend effector assembly 602 with thehousing 664 omitted for clarity), theend effector assembly 602 transitions or displaces to the second deployed position 605 (illustrated inFIGS. 26A to 26C ). In particular, with reference toFIGS. 21B and 27 , thehub portion 611 of thetissue engaging assembly 600 is secured (and/or stationary) at the portion of thehousing 664 that is at or adjacent to thedistal end 668, and with the end cap segments 632 a-632 d of thetissue engaging arms 604 a-604 d configured to displace distally with theplunger 669, thetissue engaging arms 604 a-604 d change in shape from the straight configuration ofFIG. 25 to the deployed configuration ofFIGS. 26A to 26C . In this deployed configuration, with respect to the firsttissue engaging arm 604 a, thefirst mating feature 632 a of thefirst arm segment 612 a may engage a correspondingfirst mating feature 634 a of thesecond arm segment 614 a to maintain thefirst arm segment 612 a and thesecond arm segment 614 a in the desired position when theend effector assembly 602 is in the second deployedposition 605, as previously described. In addition, in the second deployedposition 605, thesecond mating feature 648 a of thesecond arm segment 614 a (or one or more portions of thesecond mating feature 648 a of thesecond arm segment 614 a) may engage a correspondingfirst mating feature 650 a of thethird arm segment 616 a (or a corresponding one or more portions of thefirst mating feature 650 a of thethird arm segment 616 a) to maintain thethird arm segment 616 a and thesecond arm segment 614 a in a desired position when theend effector assembly 602 is in the second deployedposition 605, also as previously described. - So configured, a
second segment axis 671 that extends through thesecond arm segment 614 a from thefirst end 625 a to thesecond end 626 a along thefirst arm axis 610 a is parallel to theend effector axis 665 and offset from theend effector axis 665 by a first distance D1, as illustrated inFIG. 27 . Further, afirst segment axis 672 that extends through thefirst arm segment 612 a from thefirst end 618 a to thesecond end 620 a is oblique relative to theend effector axis 665, as illustrated inFIG. 27 . In some embodiments, thefirst segment axis 672 may form an angle between 20° and 70° (such as between 35° and 55°) with theend effector axis 665. In addition, athird segment axis 674 that extends through thethird arm segment 616 a from thefirst end 628 a to thesecond end 629 a is oblique relative to theend effector axis 665, as illustrated inFIG. 27 . In some embodiments, thethird segment axis 674 may form an angle between 20° and 70° (such as between 35° and 55°) with theend effector axis 665, and this angle may be equal (but oppositely disposed) to the angle formed by thefirst segment axis 672 and theend effector axis 665, thethird segment axis 674 may be a mirror image of thefirst segment axis 672 about an axis of symmetry that is normal to theend effector axis 665. The first distance D1 separating thesecond segment axis 671 from theend effector axis 665 when theend effector assembly 602 is the second deployedposition 605 is greater than a second distance D2 (illustrated inFIG. 25 , in which the view of the firsttissue engaging arm 604 a is blocked by the housing 664) that separates thesecond segment axis 671 from theend effector axis 665 when theend effector assembly 602 is the firstundeployed position 603. In this the firstundeployed position 603 illustrated inFIG. 25 , thesecond segment axis 671 may be parallel to theend effector axis 665. Further, in this firstundeployed position 603, thefirst segment axis 672, thesecond segment axis 671, and thethird segment axis 674 may all be coaxially aligned and may each be parallel to or substantially parallel to theend effector axis 665. - Turning to
FIG. 26C , in the second deployedposition 605, thesecond arm segment 614 a may be completely external to thehousing 664, while a portion of thefirst arm segment 612 a may extend through thefirst window 666 a such that thefirst end 618 a (seeFIG. 24A ) of thefirst arm segment 612 a is disposed within thehousing interior 676 of the housing 664 (or within the aperture in thehousing 664 forming thefirst window 666 a) and thesecond end 620 a of thefirst arm segment 612 a is disposed external to thehousing 664. Alternatively, in some embodiments, all or a portion of thefirst hinge 622 a (seeFIG. 24A ) may be disposed within thehousing interior 676 of thehousing 664, while thefirst end 618 a of thefirst arm segment 612 a may be disposed exterior to thehousing 664 but adjacent (e.g., immediately adjacent to) the aperture in thehousing 664 forming thefirst window 666 a. Similarly, in the second deployedposition 605, a portion of thethird arm segment 616 a may extend through thefirst window 666 a such that thesecond end 629 a (seeFIG. 24A ) of thethird arm segment 616 a is disposed within thehousing interior 676 of the housing 664 (or within an aperture in thehousing 664 forming thefirst window 666 a) and thefirst end 628 a (seeFIG. 24A ) of thethird arm segment 616 a is disposed external to thehousing 664. Alternatively, in some embodiments, all or a portion of thefourth hinge 633 a (seeFIG. 24A ) may be disposed within thehousing interior 676 of thehousing 664, while thesecond end 629 a of thethird arm segment 616 a may be disposed exterior to thehousing 664 but adjacent (e.g., immediately adjacent to) the aperture in thehousing 664 forming thefirst window 666 a. - Any or all of the second
tissue engaging arm 604 b, the thirdtissue engaging arm 604 b, and the fourthtissue engaging arm 604 d may each displace or transition identically to the firsttissue engaging arm 604 a when theend effector assembly 602 is displaced from the firstundeployed position 603 to the second deployedposition 605 and vice versa, as illustrated inFIGS. 25 to 27 . Accordingly, the firsttissue engaging arm 604 a, the secondtissue engaging arm 604 b, the thirdtissue engaging arm 604 b, and the fourthtissue engaging arm 604 d may be disposed physically offset from each other but otherwise in an identical manner in each of the firstundeployed position 603 and the second deployedposition 605 and any point in between. - The embodiment of the
end effector assembly 602 may be coupled to thehandle portion 12 of thetissue manipulation device 10 previously described. However, with reference toFIGS. 28A to 28G , the embodiment of theend effector assembly 602 may be coupled to an embodiment of atissue manipulation device 700 that may have abody portion 702 that may include agrip portion 703 that is configured to be grasped by a single hand of a user during the procedure. In such an embodiment, as illustrated in the cross-sectional view ofFIG. 29B , a portion of theshaft portion 40 at or adjacent to (or distal to) theproximal end 42 of theshaft portion 40 may be coupled to afirst portion 704 of thebody portion 702. In addition, anadjustment wheel 710 may be rotatably coupled to asecond portion 705 of thebody portion 702. Theadjustment wheel 710 may rotate relative to thesecond portion 705 of thebody portion 702 about awheel axis 709 that may be parallel to the X-axis of the reference coordinate system ofFIG. 29B . Theadjustment wheel 710 may be similar in form and function to theadjustment wheel 122 previously described, and theadjustment wheel 710 may be coupled to theend effector assembly 602 to rotate theend effector assembly 602 about the end effector axis 665 (seeFIG. 28A ) relative to thedistal end 44 of theshaft portion 40. - To turn the
adjustment wheel 710, theadjustment wheel 710 may be displaced distally (against the proximally-directed bias force provided by spring 712) by the user (not shown) from a locked position (illustrated inFIGS. 30A and 30B ) to an unlocked position (illustrated inFIGS. 31A and 31B ) to unlock theadjustment wheel 710 and allow theadjustment wheel 710 to rotate about thewheel axis 709. Advantageously, theadjustment wheel 710 may be displaced distally when the user is gripping thegrip portion 703 and uses a finger (e.g., a thumb) of the hand gripping thegrip portion 703 to unlock and rotate theadjustment wheel 710. When theadjustment wheel 710 has been rotated to a desired position, the user may release theadjustment wheel 710 which may then be displaced proximally by thespring 712 to the locked position in which theadjustment wheel 710 is unable to rotate. - With reference to
FIG. 31A , theadjustment wheel 710 may include anengagement portion 718 that may be circular or substantially circular in cross-sectional shape, and theengagement portion 718 may have the shape of a disk. A portion of theengagement portion 718 may extend out of ahousing slot 722 formed in thehousing portion 704. Acentral aperture 724 be formed through theengagement portion 718, and a plurality of lockingslots 714 may extend radially along an inner edge forming thecentral aperture 724. Apost 716 that is adapted to be received into any one of the plurality of lockingslots 714 may be secured to acylindrical hub 726. Thecylindrical hub 726 may be fixed relative to thehousing portion 704 such that when thepost 716 is received into any one of the plurality of lockingslots 714, theadjustment wheel 710 is in the locked position and thus prevented from rotating relative to thecylindrical hub 726, as illustrated inFIGS. 30A and 30B . However, when theadjustment wheel 710 is displaced distally (against the proximally-directed bias force provided by spring 712) by the user from the locked position to the unlocked position (illustrated inFIGS. 31A and 31B ), theengagement portion 718 displaces distally relative to the post 716 (and the cylindrical hub 726) until thepost 716 is no longer disposed in any one of the plurality of lockingslots 714. So positioned, theadjustment wheel 710 may be rotated freely about thewheel axis 709 by a user until the user ceases to force theadjustment wheel 710 in a distal direction, at which time thespring 712 displaces theadjustment wheel 710 proximally such that one of the plurality of lockingslots 714 that is aligned with thepost 716 receives thepost 716 to lock theadjustment wheel 710 into the locked position ofFIGS. 30A and 30B . - With reference to
FIG. 29A , thetissue manipulation device 700 may also have anadjustment member 708 that may be similar in form and identical in function to theadjustment member 22, and theadjustment member 708 may be coupled to theend effector assembly 602 to transition theend effector assembly 602 between the first undeployed position 603 (illustrated inFIG. 25 ) and the second deployed position 605 (illustrated inFIGS. 26A to 26C ). In particular, theadjustment member 708 may be elongated and extend along alongitudinal axis 741 from aproximal end 734 to a distal end 736, and thelongitudinal axis 741 may be coaxially aligned with thewheel axis 709. Aninsertion portion 738 may extend from the distal end 736 to an intermediary point 739, and aninput portion 740 may extend proximally from theinsertion portion 738 from the intermediary point 739 to theproximal end 734 of theadjustment member 708. Theinsertion portion 738 may be at least partially received in acentral bore 742 of thecylindrical hub 726, and a threaded portion 744 of anouter surface 746 of theinsertion portion 738 may threadedly engage a threaded portion 748 of thecentral bore 742 ofcylindrical hub 726. - The
adjustment member 708 may be coupled to theend effector assembly 602 by anelongated coupling portion 733 such that displacing theadjustment member 708 displaces thecoupling portion 733 and transitions theend effector assembly 602 between the first undeployed position 603 (illustrated inFIG. 29A ) and the second deployed position 605 (illustrated inFIG. 29B ). Thecoupling portion 733 may include awire 732 that may be similar or identical to thewire 52 previously discussed. That is, aproximal end 730 of thewire 732 may be secured to a portion of theadjustment member 708, such as a portion at or adjacent to the distal end 736 of theadjustment member 708, and adistal end 731 of thewire 732 may be secured to theend effector assembly 602 in any suitable manner, and may be secured to theplunger 669 in the same manner as thedistal end 56 of thewire 52 is coupled to the end effector 48 (as illustrated inFIG. 3 ). Accordingly, when a user rotates the input portion 740 (relative to thecylindrical hub 726 and the body portion 702) about thelongitudinal axis 741 in a first rotational direction, theadjustment member 708 displaces distally along thelongitudinal axis 741 from a first adjustment member position (illustrated inFIG. 29A ) to a second adjustment member position (illustrated inFIG. 29B ), thereby distally displacing thedistal end 731 of thewire 732 to transition theend effector assembly 602 from the first undeployed position 603 (illustrated inFIG. 29A ) to the second deployed position 605 (illustrated inFIG. 29B ). Correspondingly, when the user rotates the input portion 740 (relative to the relative to thecylindrical hub 726 and the body portion 702) about thelongitudinal axis 741 in a second rotational direction, theadjustment member 708 displaces proximally along thelongitudinal axis 741 from the second adjustment member position (illustrated inFIG. 29B ) to the first adjustment member position (illustrated inFIG. 29A ), thereby proximally displacing thedistal end 731 of thewire 732 to transition theend effector assembly 602 from the second deployed position 605 (illustrated inFIGS. 29B ) to the first undeployed position 603 (illustrated inFIG. 29A ). Further, the when the user rotates theinput portion 740 about thelongitudinal axis 741 such that theadjustment member 708 displaces between the second adjustment member position and the first adjustment member position, theend effector assembly 602 may be transitioned to a semi-deployed position between the firstundeployed position 603 and the second deployedposition 605. - Referring again to
FIG. 1 , thetissue manipulation device port 214 configured to deliver fluids to a treatment area. For example, theport 214 may extend from a portion of thehousing portion 12, such as a portion of thedistal support portion 112 of thewheel housing portion 108. In other embodiments, theport 214 may be coupled to a portion of theshaft portion 40, as illustrated inFIGS. 28A and 29A . As illustrated inFIG. 3 , theport 214 may be cylindrical and may extend from aninner end 216 to anouter end 218 along an axis that may be transverse to thelongitudinal axis 14. Theinner end 216 may be in communication with a chamber 219 within thedistal support portion 112 and adjacent to theproximal end 42 of theshaft portion 40. One or more seals may be disposed on thewheel hub 170 to prevent fluid in the chamber 219 from moving proximally. Theshaft portion 40 may include a plurality ofapertures 220 that may be at least partially disposed on thecurved portion 142 of theshaft portion 40. Each of the plurality ofapertures 220 extends from theexterior surface 145 of theshaft portion 40 to the shaftinterior portion 146. One or more seals may be disposed distal to the plurality ofapertures 220 to prevent fluid from moving distal to the one or more seals. As such, when a fluid is introduced into theouter end 218 of theport 214, the fluid travels through theport 214 and into the chamber 219, where the fluid enters the shaftinterior portion 146 and travels distally towards the plurality ofapertures 220, where the fluid exits each of the plurality ofapertures 220. One having ordinary skill in the art would recognize that the fluid would flow in any gaps or passages associated with components disposed within the shaftinterior portion 146. For example, one having ordinary skill in the art would recognize that the fluid would flow through the link bores 286 of the torque links 58 or through gaps between the torque links 58 and portions of the one or moreinterior surfaces 147 defining the shaftinterior portion 146. Theouter end 218 of theport 214 may be configured to connect to a source of fluid, and may have a luer fitting, for example. The fluid may be a liquid or gas that may be delivered to a treatment area of a patient that is at or adjacent to at least one of the plurality ofapertures 220. In operation, fluid may also be removed from the treatment area by entering any of the plurality ofapertures 220 and exiting theouter end 218 of theport 214. - The
tissue manipulation device 10 may be fabricated using any suitable material or combination of materials, such as materials that allow for the cleaning and sterilization of all or parts of the tissue manipulation device 10 (e.g., a plastic material or stainless steel). For example, all or portions of thehandle portion 12, theshaft portion 12, and theend effector 48 may all be composed or made from stainless steel or plastic. - In operation, the
tissue manipulation device tissue manipulation device curved portion 142 of theshaft portion 40 allows theshaft portion 40 to travel along the patient's urethra and past the bony diaphragm structure of the pelvis until thedistal end housing end effector adjustment member Barbs 38 and 46 on the tissue engaging members facilitate gripping of the prostate. Although the tissue engaging members 20 (or the tissue engaging arms 604) are shown fully extended, inFIG. 8 , they may be extended to any desired degree by the surgeon between the undeployed position and full extension. The prostate's position can then be manipulated as needed to facilitate prostatectomy. The positioning of the prostate is provided under control of the surgeon, such as, raised or lowered by adjusting the tilt angle of theshaft portion 40 with respect to the patient's body, pulled or pushed by changing the extent of theshaft portion 40 passing through the urethra (i.e., slightly pushing or pulling thehandle potion 12 or grip portion 703), and, advantageously, bi-directionally rotated using theadjustment wheel tissue manipulation device adjustment member - The
tissue manipulation device tissue manipulation device 10 allows for precise dissection thereby minimizing the risk of damage to the neurovascular bundles and other tissue about the prostate. - In some embodiments, the
tissue manipulation device 10 may be configured for use in a robotic surgical procedure. For example, a robot (not shown) with a dynamic member, such as an arm, my interface with an embodiment of thetissue manipulation device 10 to position thetissue manipulation device 10 during the procedure. The robot, via a first robotic interface 236 (an embodiment of which is illustrated inFIG. 14A ) be directly or indirectly coupled to thetissue manipulation device 10 to rotate the adjustment wheel 122 (or an equivalent mechanism or gear) to rotate theend effector 48 about theend effector axis 153 relative to thedistal end 44 of theshaft portion 40 to precisely position theend effector 48 during a procedure. The firstrobotic interface 236 may be any mechanism, assembly, or device that may interact or interface with thetissue manipulation device 10 to cause the adjustment wheel 122 (or any portion of the rotational assembly coupled to the adjustment wheel 122) to rotate. For example, in the embodiment ofFIG. 14A , the firstrobotic interface 236 may be a gear 238 that interfaces with the adjustment wheel 122 (or an equivalent gear that acts as the adjustment wheel 122) to rotate theadjustment wheel 122. Instead of a single gear 238, the firstrobotic interface 236 may include any number or combination of gears to turn theadjustment wheel 122 to a desired position. In other embodiments, such as that ofFIG. 14C , the firstrobotic interface 236 may be adrive pulley 240 with abelt 242 that is coupled theadjustment wheel 122 to rotate theadjustment wheel 122. In the embodiment ofFIG. 14B , thedrive pulley 240 andbelt 242 may be coupled to a pulley equivalent to theadjustment wheel 122 to rotate theadjustment wheel 122. - In other embodiments, the robot, via a second robotic interface 246 (an embodiment of which is illustrated in
FIG. 15A ), may be directly or indirectly coupled to thetissue manipulation device 10 to displace thewire 52 such that theend effector 48 is displaced from the first undeployed position 49 (illustrated inFIGS. 1 and 6 ) to the second deployed position 51 (illustrated inFIG. 8 ). The secondrobotic interface 246 may be any mechanism, assembly, or device that may interact or interface with thetissue manipulation device 10 to cause (a) the adjustment member 22 (or any portion of the rotational assembly coupled to the adjustment member 22) to rotate and/or (b) thewire 52 to longitudinally displace. For example, in the embodiment ofFIG. 15A , the secondrobotic interface 246 may be agear 248 that interfaces with the adjustment member 22 (or an equivalent gear that acts as the adjustment member 22) to rotate theadjustment member 22. Instead of asingle gear 248, the secondrobotic interface 246 may include any number or combination of gears to turn theadjustment member 22 to a desired position. In other embodiments, such as that ofFIG. 15A , the secondrobotic interface 246 may be adrive pulley 250 with abelt 252 that is coupled theadjustment member 22 to rotate theadjustment member 22. In some embodiments, the robot will include both the firstrobotic interface 236 and the secondrobotic interface 246, or may include either the firstrobotic interface 236 or the secondrobotic interface 246. Thetissue manipulation device 700 may be configured for use in such a robotic surgical procedure in a similar manner. - It will be apparent to those skilled in the art that the foregoing detailed disclosure is intended to be presented by way of example only, and is not limiting. Various alterations, improvements, and modifications will occur and are intended to those skilled in the art, though not expressly stated herein. These alterations, improvements, and modifications are intended to be suggested hereby, and are within the spirit and the scope of the claimed invention. The drawings included herein are not necessarily drawn to scale. Additionally, the recited order of processing elements or sequences, or the use of numbers, letters, or other designations, therefore, is not intended to limit the claims to any order, except as may be specified in the claims. Accordingly, the invention is limited only by the following claims and equivalents thereto.
Claims (20)
1. A tissue manipulation device for minimally invasive surgery, comprising:
a body portion;
a shaft portion extending from a proximal end to a distal end along a shaft axis, wherein a portion of the shaft portion is coupled to a first portion of the body portion, and wherein the shaft portion includes one or more interior surfaces defining an interior portion;
an adjustment member coupled to a second portion of the body portion, the adjustment member being displaceable relative to the second portion of the body portion from a first adjustment member position to a second adjustment member position;
an elongated coupling portion, wherein a first portion of the coupling portion is coupled to a portion of the adjustment member, and wherein at least a portion of the coupling portion extends through the interior portion of the shaft portion; and
an end effector assembly comprising;
a housing extending from a proximal end to a distal end along an end effector axis, wherein the proximal end is coupled to the distal end of the shaft portion, wherein a first window extends along a first elongated portion of the housing from a proximal end to a distal end along an axis parallel to the end effector axis, and wherein a second window extends along a second elongated portion of the housing from a proximal end to a distal end along an axis parallel to the end effector axis, and wherein the housing defines a housing interior; and
a tissue engaging assembly comprising:
a first tissue engaging arm that includes a first arm segment, a second arm segment, and a third arm segment, the first arm segment of the first tissue engaging arm extending from a first end to a second end along a first arm segment axis, the second arm segment of the first tissue engaging arm extending from a first end to a second end along a second arm segment axis, and the third arm segment of the first tissue engaging arm extending from a first end to a second end along a third arm segment axis, wherein the first end of the first arm segment of the first tissue engaging arm is pivotably coupled to a portion of the housing at or adjacent to the distal end of the housing;
a second tissue engaging arm that includes a first arm segment, a second arm segment, and a third arm segment, the first arm segment of the second tissue engaging arm extending from a first end to a second end along a first arm segment axis, the second arm segment of the second tissue engaging arm extending from a first end to a second end along a second arm segment axis, and the third arm segment of the second tissue engaging arm extending from a first end to a second end along a third arm segment axis, wherein the first end of the first arm segment of the second tissue engaging arm is pivotably coupled to the portion of the housing at or adjacent to the distal end of the housing; and
a plunger coupled to a second portion of the coupling portion, wherein the second end of the third arm segment of the first tissue engaging arm is coupled to a first portion of the plunger, and the second end of the third arm segment of the second tissue engaging arm is coupled to a second portion of the plunger, the plunger being disposed within the housing interior when the adjustment member is in the second adjustment member position, and the plunger being displaceable long the end effector axis when the adjustment member is displaced between the first adjustment member position and the second adjustment member position,
wherein when the adjustment member is in the first adjustment member position, the end effector assembly is in a first undeployed position, in which:
the second arm segment axis of the first tissue engaging arm is parallel to and offset from the end effector axis by a first distance; and
the second arm segment axis of the second tissue engaging arm is parallel to and offset from the end effector axis by a second distance, and
when the adjustment member is in the second adjustment member position, the end effector assembly is in a second deployed position, in which:
the second arm segment axis of the first tissue engaging arm is parallel to and offset from the end effector axis by a third distance that is greater than the first distance;
the second arm segment axis of the second tissue engaging arm is parallel to and offset from the end effector axis by a fourth distance that is greater than the second distance;
a portion of the first arm segment of the first tissue engaging arm and a portion of the third arm segment of the first tissue engaging arm each extends through a corresponding portion of the first window of the housing; and
a portion of the first arm segment of the second tissue engaging arm and a portion of the third arm segment of the second tissue engaging arm each extends through a corresponding portion of the second window of the housing.
2. The tissue manipulation device of claim 1 , wherein the first distance is equal to the second distance, and the third distance is equal to the fourth distance.
3. The tissue manipulation device of claim 2 , wherein a portion of the shaft axis is non-linear.
4. The tissue manipulation device of claim 3 , wherein the portion of the shaft axis has an arcuate shape.
5. The tissue manipulation device of claim 4 , wherein the portion of the shaft axis extends from a first point that is disposed between the proximal end of the shaft portion and the distal end of the shaft portion to a second point that is at or adjacent to the distal end of the shaft portion.
6. The tissue manipulation device of claim 1 , wherein when the end effector assembly is in the first undeployed position:
the first arm segment axis of the first arm segment of the first tissue engaging arm, the second arm segment axis of the second arm segment of the first tissue engaging arm, and the third arm segment axis of the third arm segment of the first tissue engaging arm are each coaxially aligned and parallel to the end effector axis; and
the first arm segment axis of the first arm segment of the second tissue engaging arm, the second arm segment axis of the second arm segment of the second tissue engaging arm, and the third arm segment axis of the third arm segment of the second tissue engaging arm are each coaxially aligned and parallel to the end effector axis.
7. The tissue manipulation device of claim 6 , wherein when the end effector assembly is in the second deployed position:
the first arm segment axis of the first arm segment of the first tissue engaging arm forms a first oblique angle with the end effector axis;
the third arm segment axis of the third arm segment of the first tissue engaging arm forms a second oblique angle with the end effector axis, and
the first arm segment axis of the first arm segment of the second tissue engaging arm forms a third oblique angle with the end effector axis; and
the third arm segment axis of the third arm segment of the second tissue engaging arm forms a fourth oblique angle with the end effector axis.
8. The tissue manipulation device of claim 7 , wherein the first oblique angle, the second oblique angle, the third oblique angle, and the fourth obtuse angle are substantially equal.
9. The tissue manipulation device of claim 7 , wherein each of the first oblique angle, the second oblique angle, the third oblique angle, and the fourth obtuse angle is between 35° and 55°.
10. The tissue manipulation device of claim 1 , wherein when the end effector assembly is in the second deployed position:
the first end of the first arm segment of the first tissue engaging arm is disposed in the housing interior;
the second end of the third arm segment of the first tissue engaging arm is disposed in the housing interior;
the first end of the first arm segment of the second tissue engaging arm is disposed in the housing interior; and
the second end of the third arm segment of the second tissue engaging arm is disposed in the housing interior.
11. The tissue manipulation device of claim 1 , wherein the second end of the third arm segment of the first tissue engaging arm is pivotably coupled to the first portion of the plunger, and the second end of the third arm segment of the second tissue engaging arm is pivotably coupled to the second portion of the plunger.
12. The tissue manipulation device of claim 1 , wherein the first end of the first arm segment of the first tissue engaging arm is pivotably coupled to a first portion of a hub that is secured to the portion of the housing at or adjacent to the distal end of the housing, and the first end of the first arm segment of the second tissue engaging arm is pivotably coupled to a second portion of the hub.
13. The tissue manipulation device of claim 12 , wherein:
the second end of the first arm segment of the first tissue engaging arm is pivotably coupled to the first end of the second arm segment of the first tissue engaging arm by a first living hinge;
the second end of the second arm segment of the first tissue engaging arm is pivotably coupled to the first end of the third arm segment of the first tissue engaging arm by a second living hinge;
the first end of the first arm segment of the first tissue engaging arm is pivotably coupled to the first portion of the hub by a third living hinge;
the second end of the first arm segment of the second tissue engaging arm is pivotably coupled to the first end of the second arm segment of the second tissue engaging arm by a fourth living hinge;
the second end of the second arm segment of the second tissue engaging arm is pivotably coupled to the first end of the third arm segment of the second tissue engaging arm by a fifth living hinge; and
the first end of the first arm segment of the second tissue engaging arm is pivotably coupled to the second portion of the hub by a sixth living hinge.
14. The tissue manipulation device of claim 1 , wherein the proximal end of the housing is rotatably coupled to the distal end of the shaft portion such that the housing and the tissue engaging assembly of the end effector assembly rotates about the end effector axis relative to the distal end of the shaft portion.
15. The tissue manipulation device of claim 14 , further comprising an adjustment wheel coupled to the proximal end of the housing and to a third portion of the body portion such that the adjustment wheel is configured to rotate about a wheel axis relative to the body portion, the adjustment wheel being linearly displaceable along the wheel axis from a locked position, in which rotation of the adjustment wheel about the wheel axis is prevented, to an unlocked position, in which rotation of the adjustment wheel about the wheel axis rotates the housing about the end effector axis relative to the distal and of the shaft portion.
16. The tissue manipulation device of claim 15 , further comprising a post fixed relative to the housing, and the adjustment wheel further comprising a plurality of locking slots, wherein in the locked position, the post is disposed within a corresponding one of the plurality of locking slots to prevent rotation of the adjustment wheel about the wheel axis, and in the unlocked position, the post is disposed remote from each of the plurality of locking slots to allow rotation of the adjustment wheel about the wheel axis.
17. The tissue manipulation device of claim 1 , wherein the plunger is disposed within the housing interior when the adjustment member is in the first adjustment member position.
18. The tissue manipulation device of claim 1 , wherein the portion of the shaft portion coupled to the first portion of the body portion is disposed at adjacent to the proximal end of the shaft portion.
19. The tissue manipulation device of claim 1 , wherein the coupling portion is a wire, and wherein a proximal end of the wire is coupled to the portion of the adjustment member, and a distal end of the wire is coupled to the plunger.
20. The tissue manipulation device of claim 1 , the housing of the end effector assembly further comprising:
a third window extending along a third elongated portion of the housing from a proximal end to a distal end along an axis parallel to the end effector axis; and
a fourth window extending along a fourth elongated portion of the housing from a proximal end to a distal end along an axis parallel to the end effector axis; and
the tissue engaging assembly further comprising:
a third tissue engaging arm that includes a first arm segment, a second arm segment, and a third arm segment, the first arm segment of the third tissue engaging arm extending from a first end to a second end along a first arm segment axis, the second arm segment of the third tissue engaging arm extending from a first end to a second end along a second arm segment axis, and the third arm segment of the third tissue engaging arm extending from a first end to a second end along a third arm segment axis, wherein the first end of the first arm segment of the third tissue engaging arm is pivotably coupled to the portion of the housing at or adjacent to the distal end of the housing, and wherein the second end of the third arm segment of the third tissue engaging arm is coupled to a third portion of the plunger;
a fourth tissue engaging arm that includes a first arm segment, a second arm segment, and a third arm segment, the first arm segment of the fourth tissue engaging arm extending from a first end to a second end along a first arm segment axis, the second arm segment of the fourth tissue engaging arm extending from a first end to a second end along a second arm segment axis, and the third arm segment of the fourth tissue engaging arm extending from a first end to a second end along a third arm segment axis, wherein the first end of the first arm segment of the fourth tissue engaging arm is pivotably coupled to the portion of the housing at or adjacent to the distal end of the housing, and wherein the second end of the third arm segment of the fourth tissue engaging arm is coupled to a fourth portion of the plunger,
wherein in the first undeployed position:
the second arm segment axis of the third tissue engaging arm is parallel to and offset from the end effector axis by a fifth distance, and
the second arm segment axis of the fourth tissue engaging arm is parallel to and offset from the end effector axis by a sixth distance, and
wherein in the second deployed position:
the second arm segment axis of the third tissue engaging arm is parallel to and offset from the end effector axis by a seventh distance that is greater than the fifth distance,
the second arm segment axis of the fourth tissue engaging arm is parallel to and offset from the end effector axis by an eighth distance that is greater than the sixth distance,
a portion of the first arm segment of the third tissue engaging arm and a portion of the third arm segment of the third tissue engaging arm each extends through a corresponding portion of the third window of the housing, and
a portion of the first arm segment of the fourth tissue engaging arm and a portion of the third arm segment of the fourth tissue engaging arm each extends through a corresponding portion of the fourth window of the housing.
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US18/209,162 US20240050117A1 (en) | 2021-09-17 | 2023-06-13 | Tissue manipulation device |
EP23179808.3A EP4292543A1 (en) | 2022-06-16 | 2023-06-16 | Tissue manipulation device |
Applications Claiming Priority (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US202163245310P | 2021-09-17 | 2021-09-17 | |
US202263335937P | 2022-04-28 | 2022-04-28 | |
US202263352867P | 2022-06-16 | 2022-06-16 | |
US17/945,819 US11857174B2 (en) | 2021-09-17 | 2022-09-15 | Tissue manipulation device |
US202263424840P | 2022-11-11 | 2022-11-11 | |
US18/209,162 US20240050117A1 (en) | 2021-09-17 | 2023-06-13 | Tissue manipulation device |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US17/945,819 Continuation-In-Part US11857174B2 (en) | 2021-09-17 | 2022-09-15 | Tissue manipulation device |
Publications (1)
Publication Number | Publication Date |
---|---|
US20240050117A1 true US20240050117A1 (en) | 2024-02-15 |
Family
ID=89847160
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US18/209,162 Pending US20240050117A1 (en) | 2021-09-17 | 2023-06-13 | Tissue manipulation device |
Country Status (1)
Country | Link |
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US (1) | US20240050117A1 (en) |
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2023
- 2023-06-13 US US18/209,162 patent/US20240050117A1/en active Pending
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